title: Patient-important benefits of clearing the hepatitis C virus through treatment: a simulation model.
abstract: OBJECTIVE
  Given an appreciable risk of adverse-effects, current therapies for chronic hepatitis C virus (HCV) infection pose a dilemma to patients. We explored, via simulation modelling, patient-important benefits of attaining a sustained viral response (SVR).
  
  
  METHODS
  We created the HCV Individualised Treatment-decision model (the HIT-model) to simulate, on a per patient basis, the lifetime course of HCV-related liver disease according to two distinct scenarios: (i) SVR attained, and (ii) SVR not attained. Then, for each model subject, the course of liver disease under these alternative scenarios was compared. The benefit of SVR was considered in terms of two patient-important outcomes: (1) the percent-probability that SVR confers additional life-years, and (2) the percent-probability that SVR confers additional healthy life-years, where "healthy" refers to years spent in compensated disease states (i.e., the avoidance of liver failure).
  
  
  RESULTS
  The benefit of SVR varied strikingly. It was lowest for patients aged 60 years with initially mild fibrosis; 1.6% (95% CI: 0.8-2.7) and 2.9% (95% CI: 1.5-4.7) probability of gaining life-years and healthy life-years, respectively. Whereas it was highest for patients with initially compensated cirrhosis aged 30 years; 57.9% (95% CI: 46.0-69.0) and 67.1% (95% CI: 54.1-78.2) probability of gaining life-years and healthy life-years, respectively.
  
  
  CONCLUSIONS
  For older patients with less advanced liver fibrosis, SVR is less likely to confer benefit when measured in terms of averting liver failure and premature death. These data have important implications. Foremost, it may inform the contemporary patient dilemma of immediate treatment with existing therapies (that have poor adverse effect profiles) vs. awaiting future regimens that promise better tolerability.
authors: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: Hamish.innes@nhs.net.
authors: Hamish
authors: H
authors: Innes
authors: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors: David
authors: D
authors: Goldberg
authors: UCL Institute of Liver and Digestive Disease, Royal Free Hospital, London, UK.
authors: Geoffrey
authors: G
authors: Dusheiko
authors: Royal Infirmary Edinburgh, Edinburgh, UK.
authors: Peter
authors: P
authors: Hayes
authors: Gartnavel General Hospital, Glasgow, UK.
authors: Peter R
authors: PR
authors: Mills
authors: Ninewells Hospital and Medical School, Dundee, UK.
authors: John F
authors: JF
authors: Dillon
authors: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors: Esther
authors: E
authors: Aspinall
authors: Glasgow Royal Infirmary, Glasgow, UK.
authors: Stephen T
authors: ST
authors: Barclay
authors: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors: Sharon J
authors: SJ
authors: Hutchinson
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D016174:Hepacivirus / Q000187:drug effects*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012254:Ribavirin / Q000627:therapeutic use; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin
keywords: Adverse effects; Antiviral treatment; Chronic hepatitis C; Hepatitis C; Markov model; Patient-centred; Patient-important outcomes; Risk-benefit ratio; Simulation model