Should we treat acute hepatitis C? A decision and cost-effectiveness analysis

Area of Science:

• Hepatology
• Health Economics
• Infectious Diseases

Background:

• Standard practice does not include treating acute hepatitis C virus (HCV) infection.
• The rising incidence of HCV in the United States necessitates re-evaluation of acute HCV management strategies.
• Direct-acting antiviral (DAA) agents offer new therapeutic possibilities for HCV.

Purpose of the Study:

• To analyze the trade-offs between initiating HCV therapy during the acute versus chronic phase of infection.
• To project long-term clinical outcomes and costs associated with different HCV treatment timings.
• To determine the cost-effectiveness of treating acute HCV in the era of DAAs.

Main Methods:

• Development of a microsimulation model to simulate the lifetime clinical course of patients with acute HCV infection.
• Projection of long-term outcomes, including quality-adjusted life years (QALYs) and costs.
• Calculation of the incremental cost-effectiveness ratio (ICER) for acute HCV treatment versus deferred treatment.

Main Results:

• Treating acute HCV increased QALYs by 0.02 and costs by $483 in patients not at risk of transmission, with an ICER of $19,991 per QALY.
• Treatment of acute HCV was found to be cost-effective, with a willingness-to-pay threshold of $100,000 per QALY.
• In patients at risk of transmitting HCV, treating acute HCV was cost-saving, increasing QALYs by 0.03 and decreasing costs by $3,655.

Conclusions:

• Immediate treatment of acute HCV with DAAs improves clinical outcomes.
• Acute HCV treatment is highly cost-effective or cost-saving compared to deferring treatment.
• Current HCV guidelines should be revisited to incorporate the benefits of treating acute HCV with DAAs.