Hill Lucas A, Delmonte Ronnie J, Andrews Barbara, Richards Lisa, Soto Robin, Collier Summer, Kuo Alexander, Cachay Edward
Departments of Pharmacy.
Hepatology.
Eur J Gastroenterol Hepatol. 2018 Nov;30(11):1378-1383. doi: 10.1097/MEG.0000000000001195.
The availability of direct-acting antivirals (DAA) for the treatment of hepatitis C (HCV) has resulted in the ability to safely and effectively treat patients with cirrhosis and end-stage liver disease. However, information is limited with regard to the impact of DAA treatment on inpatient health-related resource utilization in patients with advanced HCV-related cirrhosis. We aimed to ascertain the impact of DAA treatment on the frequency of liver-related hospitalizations and associated costs in patients with cirrhosis.
Retrospective cohort analysis carried out at a single US reference center that compared patients with HCV cirrhosis according to treatment status: the untreated group (January 2011 to December 2013) and the DAA-treated group (January 2014 to March 2017). The primary outcome was the difference in the incidence rate of liver-related hospitalizations. Secondary outcomes included differences in the incidence of hepatocellular carcinoma, liver transplant, and all-cause mortality. We calculated the projected savings per-patient treated per-year on the basis of calculated hospitalization rate stratified by Child-Turquotte-Pugh (CTP) score.
Baseline characteristics were similar between the untreated (n=182) and DAA-treated (n=196) cohorts. Mean follow-up time in the untreated and treated cohort was 20.4 and 17.7 months, respectively. The incidence rates of liver-related hospitalizations were 29.1/100 and 10.4/100 person-years of follow-up (P≤0.0001) in the untreated and treated cohorts, respectively. This was accounted for by a decreased incidence of hospitalizations in patients with CTP-A (75.8%) and CTP-B (64.5%), but not CTP-C.
Successful DAA treatment reduces hospitalization rate and resource utilization costs in patients with CTP-A and CTP-B, but not in those with CTP-C.
直接作用抗病毒药物（DAA）可用于治疗丙型肝炎（HCV），这使得安全有效地治疗肝硬化和终末期肝病患者成为可能。然而，关于DAA治疗对晚期HCV相关肝硬化患者住院期间与健康相关资源利用的影响，相关信息有限。我们旨在确定DAA治疗对肝硬化患者肝脏相关住院频率及相关费用的影响。
在美国一家参考中心进行回顾性队列分析，根据治疗状态对HCV肝硬化患者进行比较：未治疗组（2011年1月至2013年12月）和DAA治疗组（2014年1月至2017年3月）。主要结局是肝脏相关住院发病率的差异。次要结局包括肝细胞癌、肝移植和全因死亡率的发病率差异。我们根据按Child-Turquotte-Pugh（CTP）评分分层计算的住院率，计算了每年每位接受治疗患者的预计节省费用。
未治疗组（n = 182）和DAA治疗组（n = 196）队列的基线特征相似。未治疗组和治疗组的平均随访时间分别为20.4个月和17.7个月。未治疗组和治疗组肝脏相关住院的发病率分别为每100人年随访29.1次和10.4次（P≤0.0001）。这是由于CTP-A（75.8%）和CTP-B（64.5%）患者的住院发病率降低，但CTP-C患者未降低。
DAA治疗成功可降低CTP-A和CTP-B患者的住院率和资源利用成本，但对CTP-C患者无效。
