title: Cost-Effectiveness of New Direct-Acting Antivirals to Prevent Post-Liver Transplant Recurrent Hepatitis.
abstract: Preliminary studies on HCV-cirrhotics listed for transplant suggest that sofosbuvir in combination with ribavirin is very effective in promoting viral clearance and preventing disease recurrence. Unfortunately, the high cost of such treatment (€46 500 per 12 weeks of treatment) makes its cost-effectiveness questionable. A semi-Markov model was developed to assess the cost-effectiveness of sofosbuvir/ribavirin treatment in cirrhotic patients without HCC (HCV-CIRRH) and with HCC (HCV-HCC) listed for transplant. In the base-case analysis, the incremental cost-effectiveness ratio for 24 weeks of sofosbuvir/ribavirin was €44 875 per quality-adjusted life-year gained in HCV-CIRRH and €60 380 in HCV-HCC patients. Both results were above the willingness to pay threshold of €37 000 per quality-adjusted life-year. Our data also show that in order to remain cost-effective (with a 24-week treatment), any novel interferon-free treatment endowed with ideal efficacy should cost less than €67 224 or €95 712 in HCV-cirrhotics with and without HCC, respectively. The results shows that sofosbuvir/ribavirin therapy, given to patients listed for transplant, is not cost-effective at current prices despite being very effective, and new, more effective treatments will have little economic margins to remain cost-effective. New interferon-free combinations have the potential to revolutionize the treatment and prognosis of HCV-positive patients listed for transplant; however, without sustainable prices, this revolution is unlikely to happen.
authors.affiliation: Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.
authors.forename: P A
authors.initials: PA
authors.lastname: Cortesi
authors.affiliation: Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: L G
authors.initials: LG
authors.lastname: Mantovani
authors.affiliation: Department of Surgical and Interdisciplinary Medicine, University of Milan-Bicocca, Monza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ciaccio
authors.affiliation: Department of Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Monza, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rota
authors.affiliation: Department of Hepatology and Liver Unit, Niguarda Hospital, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mazzarelli
authors.affiliation: Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cesana
authors.affiliation: Department of Surgical and Interdisciplinary Medicine, University of Milan-Bicocca, Monza, Italy.|Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: M
authors.initials: M
authors.lastname: Strazzabosco
authors.affiliation: Department of Hepatology and Liver Unit, Niguarda Hospital, Milan, Italy.
authors.forename: L S
authors.initials: LS
authors.lastname: Belli
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000472:pathogenicity*; D006526:Hepatitis C / Q000150:complications / Q000191:economics* / Q000517:prevention & control*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012008:Recurrence
chemical_list: D000998:Antiviral Agents
keywords: Economics; liver disease; liver transplantation: auxiliary; liver transplantation: living donor; liver transplantation: split