Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.
Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL.
Med Care. 2023 Aug 1;61(8):505-513. doi: 10.1097/MLR.0000000000001870. Epub 2023 May 23.
The effects of all-oral direct-acting antivirals (DAAs) on hepatocellular carcinoma (HCC) and liver-related and all-cause mortality were assessed among Medicaid beneficiaries with hepatitis C virus (HCV).
This cohort study used 2013-2019 Arizona Medicaid data from beneficiaries with HCV aged 18-64 years.
Risks of HCC and liver-related and all-cause mortality were compared between patients with or without DAA treatment, stratified by liver disease severity, using inverse probability of treatment weighted multivariable Cox proportional hazards regression models.
Of 29,289 patients, 13.3% received DAAs. Among patients with compensated cirrhosis (CC), DAA treatment was associated with a lower risk of HCC [adjusted hazard ratio (aHR), 0.57; 95% CI, 0.37-0.88] compared with untreated patients although this association was not statistically significant for patients without cirrhosis or with decompensated cirrhosis (DCC). Compared with untreated patients, DAA treatment was associated with decreased risk of liver-related mortality for patients without cirrhosis (aHR: 0.02; 95% CI: 0.004-0.11), with CC (aHR: 0.09; 95% CI: 0.06-0.13), or with DCC (aHR: 0.20; 95% CI: 0.14-0.27). Similarly, compared with untreated patients, DAA treatment was associated with lower all-cause mortality for patients without cirrhosis (aHR: 0.10; 95% CI: 0.08-0.14), with CC (aHR: 0.07; 95% CI: 0.05-0.10), or with DCC (aHR: 0.15; 95% CI: 0.11-0.20).
Among Arizona Medicaid beneficiaries with HCV, DAA treatment was associated with decreased risk of HCC for patients with CC but not for patients without cirrhosis or with DCC. However, DAA treatment was associated with decreased risk of liver-related and all-cause mortality.
评估医疗保险受益人群中丙型肝炎病毒（HCV）患者全口服直接作用抗病毒药物（DAA）对肝细胞癌（HCC）及肝脏相关和全因死亡率的影响。
本队列研究使用了来自亚利桑那州医疗保险受益人群 2013-2019 年 HCV 年龄在 18-64 岁患者的数据。
采用逆概率治疗加权多变量 Cox 比例风险回归模型，根据肝病严重程度，比较了 DAA 治疗与未治疗患者 HCC 和肝脏相关及全因死亡率的风险。
在 29289 名患者中，13.3%接受了 DAA 治疗。在代偿性肝硬化（CC）患者中，与未治疗患者相比，DAA 治疗 HCC 的风险较低[校正风险比（aHR），0.57；95%可信区间，0.37-0.88]，但对于无肝硬化或失代偿性肝硬化（DCC）患者，这种关联无统计学意义。与未治疗患者相比，DAA 治疗与无肝硬化患者的肝脏相关死亡率降低相关（aHR：0.02；95%可信区间：0.004-0.11），与 CC 患者（aHR：0.09；95%可信区间：0.06-0.13）或与 DCC 患者（aHR：0.20；95%可信区间：0.14-0.27）。同样，与未治疗患者相比，DAA 治疗与无肝硬化患者的全因死亡率降低相关（aHR：0.10；95%可信区间：0.08-0.14），与 CC 患者（aHR：0.07；95%可信区间：0.05-0.10）或与 DCC 患者（aHR：0.15；95%可信区间：0.11-0.20）。
在亚利桑那州医疗保险受益人群中患有 HCV 的患者中，DAA 治疗与 CC 患者 HCC 风险降低相关，但与无肝硬化或 DCC 患者无关。然而，DAA 治疗与降低肝脏相关和全因死亡率相关。
