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Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus
Megan Rose Curtis1,2,3,4,5,6, Rachel L Epstein5,6,7, Pamela Pei1
1Medical Practice Evaluation Center, Massachusetts General Hospital, Boston.
Insights
Early direct-acting antiviral (DAA) therapy for children with hepatitis C virus (HCV) infection at age 3 significantly reduces lifetime healthcare costs and increases life expectancy. Treating young children with HCV offers substantial clinical and economic benefits.
Area of Science:
- Hepatology
- Pediatric Infectious Diseases
- Health Economics
Background:
- Chronic hepatitis C virus (HCV) infection is increasing among pregnant individuals in the US, with vertical transmission occurring in 7-8% of births.
- Direct-acting antiviral (DAA) therapy is now approved for children aged 3 years and older with HCV.
- The comparative clinical and economic impact of early DAA therapy in young children with HCV remains largely unknown.
Purpose of the Study:
- To develop a state-transition model to project clinical and economic outcomes for children with perinatally acquired HCV.
- To investigate the cost-effectiveness of initiating DAA treatment at various ages in children with HCV.
Main Methods:
- A state-transition model simulated the natural history and disease progression of perinatally acquired HCV in a cohort of 1000 US children from age 3 through death.
- The model compared treatment strategies involving 8 weeks of DAA therapy initiated at ages 3, 6, 12, or 18 years, alongside a no-treatment comparator.
- Key outcomes included projected life expectancy, average lifetime healthcare costs, and the incidence of cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma (HCC).
Main Results:
- Treating HCV at age 3 was associated with lower mean lifetime healthcare costs ($148,162) compared to deferring treatment until ages 6 ($164,292), 12 ($171,909), or 18 ($195,374).
- Projected life expectancy was longest when treatment began at age 3 (78.36 life years), decreasing with delayed treatment initiation.
- Early treatment at age 3 prevented an estimated 89 cases of cirrhosis, 27 cases of HCC, and 74 liver-related deaths per 1000 children compared to delaying treatment until age 6.
Conclusions:
- DAA therapy initiated at age 3 for children with HCV is projected to reduce overall healthcare costs and improve survival compared to delaying treatment until age 6 or older.
- Early intervention with DAA therapy offers significant clinical benefits, including reduced incidence of severe liver disease and mortality.
- Enhancing access to DAA therapy for young children is crucial for realizing the full clinical and economic advantages of early HCV treatment.
Importance:
Prevalence of chronic hepatitis C virus (HCV) infection among pregnant people is increasing in the US. HCV is transmitted vertically in 7% to 8% of births. Direct-acting antiviral (DAA) therapy was recently approved for children with HCV who are 3 years or older. The clinical and economic impacts of early DAA therapy for young children with HCV, compared with treating at older ages, are unknown.
Objective:
To develop a state-transition model to project clinical and economic outcomes for children with perinatally acquired HCV to investigate the cost-effectiveness of treating at various ages.
Design, Setting, And Participants:
The study team modeled the natural history of perinatally acquired HCV to simulate disease progression and costs of a simulated a cohort of 1000 US children with HCV from 3 years old through death. Added data were analyzed January 5, 2021, through July 1, 2022.
Interventions:
The study compared strategies offering 8 weeks of DAA therapy at 3, 6, 12, or 18 years old, as well as a comparator of never treating HCV.
Main Outcomes And Measures:
Outcomes of interest include life expectancy from 3 years and average lifetime per-person health care costs. Other clinical outcomes include cases of cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma (HCC).
Results:
The study team projected that treating HCV at 3 years old was associated with lower mean lifetime per-person health care costs ($148 162) than deferring treatment until 6 years old ($164 292), 12 years old ($171 909), or 18 years old ($195 374). Projected life expectancy was longest when treating at 3 years old (78.36 life years [LYs]) and decreased with treatment deferral until 6 years old (76.10 LYs), 12 years old (75.99 LYs), and 18 years old (75.46 LYs). In a cohort of 1000 children with perinatally acquired HCV, treating at 3 years old prevented 89 projected cases of cirrhosis, 27 cases of HCC, and 74 liver-related deaths compared with deferring treatment until 6 years old. In sensitivity analyses, increasing loss to follow-up led to even greater clinical benefits and cost savings with earlier treatment.
Conclusions And Relevance:
These study results showed that DAA therapy for 3-year-old children was projected to reduce health care costs and increase survival compared with deferral until age 6 years or older. Measures to increase DAA access for young children will be important to realizing these benefits.
