Atif Zaman, MD, MPH reviewing Samur S et al. Clin Gastroenterol Hepatol 2017 Jun 17.
Pretransplantation anti–hepatitis C virus therapy was cost effective only in patients with a MELD score of 21 or lower.

The direct-acting antiviral agents (DAAs) currently used for the treatment of chronic hepatitis C virus (HCV) infection are effective in patients with advanced cirrhosis as well as post–liver transplantation (LT). However, whether DAA therapy should be administered pre-LT or post-LT in patients awaiting transplantation is unclear.

Using a validated mathematical model, researchers simulated a virtual trial comparing long-term outcomes pre-LT versus post-LT. Input data were sustained virologic response rates from previous trials of sofosbuvir and ledipasvir plus ribavirin in the pre-LT and post-LT settings.

For patients with a Model for End-Stage Liver Disease (MELD) score ≤27, the quality-adjusted life year (QALY) was higher with pre-LT HCV treatment, but in those with a MELD score >27, the QALY was higher with post-LT therapy. When taking cost into account, assuming a cost of US$100,000, pre-LT treatment was cost saving for MELD scores ≤15 and cost effective for MELD scores of 16 to 21. Post-LT treatment was cost effective for MELD scores 22 to 29 and cost saving for MELD scores ≥30. Sensitivity analysis results suggested that the MELD cutoff score for cost effectiveness of 21 was robust.

CITATION(S):

Samur S et al. Cost-effectiveness of pre versus post liver transplant hepatitis C treatment with direct-acting antivirals. Clin Gastroenterol Hepatol 2017 Jun 17; [e-pub]. 

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