Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 23 February 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Oral direct-acting antivirals is cost-effective in patients waitlisted for liver transplant in the USA

A study in July's issue of Hepatology examines the treatment of patients waitlisted for liver transplant with all-oral direct-acting antivirals is a cost-effective treatment strategy in the United States.

News image

All-oral direct acting antivirals have been shown to have high safety and efficacy in treating patients with hepatitis C virus (HCV) awaiting liver transplant. 

However, there is limited empirical evidence comparing the health and economic outcomes associated with treating patients pre-liver transplant versus post-liver transplant. 

Dr Zobair Younossi and colleagues analyzed the cost-effectiveness of pre-liver transplant versus post-liver transplant treatment with an all-oral direct acting antivirals regimen among HCV patients with hepatocellular carcinoma or decompensated cirrhosis. 

The researchers constructed decision-analytic Markov models of the natural disease progression of HCV in hepatocellular carcinoma patients and decompensated cirrhosis patients waitlisted for liver transplant. 

The model followed hypothetical cohorts of 1,000 patients with a mean age of 50 over a 30-year time horizon from a third-party US payer perspective and estimated their health and cost outcomes based on pre-liver transplant versus post-liver transplant treatment with an all-oral direct acting antivirals regimen. 

The pre-liver transplant treatment strategy resulted in 12 per-patient quality-adjusted life years
Hepatology
Transition probabilities and utilities were based on the literature and hepatologist consensus. 

The team sourced sustained virological response rates from ASTRAL-4, SOLAR-1, and SOLAR-2. 

Costs were sourced from RedBook, Medicare fee schedules, and published literature. 

In the hepatocellular carcinoma analysis, the pre-liver transplant treatment strategy resulted in 12 per-patient quality-adjusted life years and $365,948 per patient lifetime costs versus 10 and $283,696, respectively, in the post-liver transplant arm. 

In the decompensated cirrhosis analysis, the pre-liver transplant treatment strategy resulted in 9 per-patient quality-adjusted life years and $304,800 per patient lifetime costs versus 8.7 and $283,789, respectively, in the post-liver transplant arm. 

The researchers found that the pre-liver transplant treatment strategy was the most cost-effective in both populations with an incremental cost-effectiveness ratio of $74,255 in hepatocellular carcinoma, and $36,583 in decompensated cirrhosis. 

Sensitivity and scenario analyses showed that results were most sensitive to the utility of patients post-liver transplant, treatment sustained virological response rates, liver transplant costs, and baseline Model for End-Stage Liver Disease score.

Dr Younossi's team comments, "The timing of initiation of antiviral treatment for HCV patients with hepatocellular carcinoma or decompensated cirrhosis relative to liver transplant is an important area of clinical and policy research."

"Our results indicate that pre-liver transplant treatment with a highly effective, all-oral direct acting antivirals regimen provides the best health outcomes and is the most cost-effective strategy for the treatment of HCV patients with hepatocellular carcinoma or decompensated cirrhosis waitlisted for liver transplant."

Hepatology 2017: 66(1): 46–56
06 July 2017

Go to top of page Email this page Email this page to a colleague

 23 February 2018 
MRI and NAFLD
 23 February 2018 
Heavy metals on a gluten-free diet
 23 February 2018 
Patients on antithrombotic agents undergoing emergency and elective endoscopy
 22 February 2018 
Autophagy enhancers
 22 February 2018 
Outcomes with Crohn’s after infliximab withdrawal
 22 February 2018 
Elderly onset of IBD

 21 February 2018 
Adalimumab and infliximab in biologic-naïve Crohn's
 21 February 2018 
Cystic fibrosis and colorectal cancer
 21 February 2018 
Management of hemorrhoids in the USA
 20 February 2018 
Treatment algorithm for polyp cancers
 20 February 2018 
Predictors of postoperative infection in Crohn's
 20 February 2018 
Complications and surveillance colonoscopies
 19 February 2018 
Screening colonoscopy in the right and left colon
 19 February 2018 
NAFLD prevalence in the USA
 19 February 2018 
Fructans in children with IBS

 16 February 2018 
Undetected celiac in the elderly
 16 February 2018 
Inflammatory bowel diseases are global diseases
 16 February 2018 
Fructans induce non-celiac gluten sensitivity
 15 February 2018 
NSAIDS and GI damage
 15 February 2018 
Oral direct-acting antiviral treatment for Hep C virus genotype 1
 15 February 2018 
Primary vs secondary surgery for the presence of lymph node metastasis
 14 February 2018 
Predicting adenoma detection rate
 14 February 2018 
Normal bowel frequency characterization in the USA 
 13 February 2018 
Personalising treatment options for IBS
 13 February 2018 
Prebiotics improve endothelial dysfunction
 13 February 2018 
Diagnostic criteria for a Rome IV functional gastrointestinal disorders
 12 February 2018 
Visceral hypersensitivity and functional GI disorders
 12 February 2018 
Depression and aggressive IBD
 12 February 2018 
Variability in interpretation of endoscopic findings impacts patient management
 09 February 2018 
Treatment of choice for anastomotic stricture in IBD
 09 February 2018 
PRO measurement information system 
 09 February 2018 
Overall disease severity indices for IBD
 08 February 2018 
Prediction of endoscopically active disease

 08 February 2018 
Steroid-refractory acute severe ulcerative colitis
 08 February 2018 
Decision aid used by IBD patients
 07 February 2018 
Ursodeoxycholic acid combined with bezafibrate for itching
 07 February 2018 
Change in microbiome in gastritis vs gastric carcinoma
 07 February 2018 
Colorectal cancer and primary sclerosing cholangitis-IBD
 06 February 2018 
Risk of death after liver transplantation
 06 February 2018 
Crohn’s disease vs refractory pouchitis
 06 February 2018 
Support for functional dyspepsia symptom diary
 05 February 2018 
Helicobacter spp influence on GI tract 
 05 February 2018 
No link found between severe reflux and all-cause mortality 
 05 February 2018 
Psychological distress in PPI non-responders
 02 February 2018 
Assessing psychosexual impact of IBD
 02 February 2018 
Decrease in overall mortality with cholera vaccination
 02 February 2018 
Diagnostic performance of fecal immunochemical tests
 01 February 2018 
Screening frequency with family histories of colorectal cancer
 01 February 2018 
IBD and sport participation
 01 February 2018 
Life with a stoma 
 31 January 2018 
Aprepitant and gastroparesis 
 31 January 2018 
Anesthesia risk in colonoscopy
 31 January 2018 
GED-0301 for Crohn's Disease
 30 January 2018 
Intestinal dysbiosis and allergic diseases in infants
 30 January 2018 
Fructans and IBS symptoms in children
 29 January 2018 
Dosing calculator for therapy optimization in IBD
 29 January 2018 
Glecaprevir–pibrentasvir for in HCV
 29 January 2018 
Food allergen injections in eosinophilic esophagitis
 29 January 2018 
Reliability of the IBD index
 26 January 2018 
Tofacitinib vs biological therapies for ulcerative colitis

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us