Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, Paris, France.
Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France.
Liver Int. 2017 Dec;37(12):1805-1813. doi: 10.1111/liv.13465. Epub 2017 May 29.
The net benefits of new hepatitis C virus (HCV) direct-acting antiviral drugs (DAA) in patients with cryoglobulinaemia vasculitis (CryoVas) are unknown.
To analyse the effectiveness and cost of all treatments used for HCV-CryoVas in the DAA vs pre-DAA era.
A chart review of all HCV-CryoVas patients who received antivirals from 1993 to 2016 in a tertiary centre was performed. Treatment effectiveness was analysed for clinical, immunological and virological responses. Cost analyses included anti-HCV treatments, non-antiviral drugs, plasmapheresis, dialysis and hospitalizations. We compared main data in the pre-DAA vs DAA period.
About 201 HCV-CryoVas patients were included (women, 53.2%; mean age, 59.2 years; Metavir score F3-F4, 36.7%; genotype 1, 64.2%). Patients in the DAA era (n=27) compared to those in the pre-DAA era (n=174) showed higher rates of clinical (96.3% vs. 78.6%), immunological (89.5% vs. 77.1%), and sustained virological response (75.0% vs. 42.8%). Death rate was 14.8% vs. 24.4% respectively. In the DAA compared to pre-DAA era, mean cost of anti-HCV drugs increased from 11 855 to 57 632 € while mean CryoVas-related cost decreased for both hospitalizations (from 33 510 to 21 347€) and non-antiviral treatments (from 17 347 to 11 397€).
Improved antiviral efficacy of HCV drugs in the DAA era led to increased clinical and immunological efficacy and a lower death rate. Use of DAAs was associated to higher costs for HCV drugs while costs related to both hospitalizations and non-antiviral treatments decreased.
新型丙型肝炎病毒（HCV）直接作用抗病毒药物（DAA）在冷球蛋白血症血管炎（CryoVas）患者中的净收益尚不清楚。
分析 DAA 时代与 DAA 时代之前所有用于 HCV-CryoVas 治疗的有效性和成本。
对 1993 年至 2016 年间在一家三级中心接受抗病毒治疗的所有 HCV-CryoVas 患者进行了图表回顾。分析了临床、免疫和病毒学反应的治疗效果。成本分析包括抗 HCV 治疗、非抗病毒药物、血浆置换、透析和住院治疗。我们比较了 DAA 前和 DAA 时期的主要数据。
共纳入 201 例 HCV-CryoVas 患者（女性占 53.2%；平均年龄 59.2 岁；Metavir 评分 F3-F4 占 36.7%；基因型 1 占 64.2%）。与 DAA 前时期（n=174）相比，DAA 时期（n=27）的患者临床（96.3%比 78.6%）、免疫（89.5%比 77.1%）和持续病毒学应答（75.0%比 42.8%）的比例更高。死亡率分别为 14.8%和 24.4%。与 DAA 前时期相比，DAA 时期抗 HCV 药物的平均费用从 11855 欧元增加到 57632 欧元，而住院治疗（从 33510 欧元降至 21347 欧元）和非抗病毒治疗（从 17347 欧元降至 11397 欧元）的费用均降低。
DAA 时代 HCV 药物抗病毒疗效的提高，导致临床和免疫疗效的提高，死亡率降低。使用 DAA 与 HCV 药物的成本增加有关，而住院治疗和非抗病毒治疗的成本均降低。
