Massachusetts General Hospital Institute for Technology Assessment, Boston, MA.
Harvard Medical School, Boston, MA.
Hepatology. 2018 Mar;67(3):837-846. doi: 10.1002/hep.29611. Epub 2018 Jan 24.
It is not standard practice to treat patients with acute hepatitis C virus (HCV) infection. However, as the incidence of HCV in the United States continues to rise, it may be time to re-evaluate acute HCV management in the era of direct-acting antiviral (DAA) agents. In this study, a microsimulation model was developed to analyze the trade-offs between initiating HCV therapy in the acute versus chronic phase of infection. By simulating the lifetime clinical course of patients with acute HCV infection, we were able to project long-term outcomes such as quality-adjusted life years (QALYs) and costs. We found that treating acute HCV versus deferring treatment until the chronic phase increased QALYs by 0.02 and increased costs by $483 in patients not at risk of transmitting HCV. The resulting incremental cost-effectiveness ratio was $19,991 per QALY, demonstrating that treatment of acute HCV was cost-effective using a willingness-to-pay threshold of $100,000 per QALY. In patients at risk of transmitting HCV, treating acute HCV became cost-saving, increasing QALYs by 0.03 and decreasing costs by $3,655.
Immediate treatment of acute HCV with DAAs can improve clinical outcomes and be highly cost-effective or cost-saving compared with deferring treatment until the chronic phase of infection. If future studies continue to demonstrate effective HCV cure with shorter 6-week treatment duration, then it may be time to revisit current HCV guidelines to incorporate recommendations that account for the clinical and economic benefits of treating acute HCV in the era of DAAs. (Hepatology 2018;67:837-846).
治疗急性丙型肝炎病毒（HCV）感染患者目前并非标准做法。然而，随着美国 HCV 发病率持续上升，可能是时候在直接作用抗病毒（DAA）药物时代重新评估急性 HCV 管理了。在这项研究中，我们开发了一个微观模拟模型来分析在感染的急性和慢性阶段开始 HCV 治疗的利弊权衡。通过模拟急性 HCV 感染患者的终生临床病程，我们能够预测长期结局，如质量调整生命年（QALY）和成本。我们发现，与延迟到慢性阶段治疗相比，在没有 HCV 传播风险的患者中，治疗急性 HCV 可增加 0.02 个 QALY 并增加 483 美元的成本。增量成本效益比为每 QALY 19991 美元，表明使用 100000 美元/QALY 的支付意愿阈值，治疗急性 HCV 具有成本效益。在有 HCV 传播风险的患者中，治疗急性 HCV 可节省成本，增加 0.03 个 QALY 并降低 3655 美元的成本。
与延迟到感染的慢性阶段治疗相比，用 DAA 立即治疗急性 HCV 可改善临床结局，并且具有很高的成本效益或成本节省。如果未来的研究继续证明用更短的 6 周治疗持续时间可有效治愈 HCV，那么可能是时候重新审查当前的 HCV 指南，纳入考虑 DAA 时代治疗急性 HCV 的临床和经济效益的建议。（《肝脏病学》2018；67：837-846）
