title: Clinical impact of treatment timing for chronic hepatitis C infection: a decision model.
abstract: Recent advances in the treatment of hepatitis C virus (HCV) infection have led to the availability of both highly efficacious interferon-containing and interferon-sparing regimens. However, the use of such therapies faces restrictions due to high costs. For patients who are medically eligible to receive interferon, the choice between the two will likely be impacted by preferences surrounding interferon, severity of disease, coverage policies and out-of-pocket costs. We developed a decision model to quantify the trade-offs between immediate, interferon-containing therapy and delayed, interferon-free therapy for patients with chronic, genotype 1 HCV infection. We projected the quality-adjusted life expectancy stratified by the presence or absence of cirrhosis for four strategies: (i) no treatment; (ii) immediate, one-time treatment with an interferon-containing regimen; (iii) immediate treatment as above with the opportunity for retreatment in patients who fail to achieve sustained virologic response with interferon-free therapy in 1 year; and (iv) delayed therapy with interferon-free therapy in 1 year. When compared to one-time immediate treatment with the interferon-containing regimen, delayed treatment with the interferon-free regimen in 1 year resulted in longer life expectancy, with a 0.2 quality-adjusted life year (QALY) increase in noncirrhotic patients, and a 1.1 QALY increase in patients with cirrhosis. This superiority in health benefits was lost when wait time for interferon-free therapy was greater than 3-3.2 years. In this modelling analysis, interferon-free therapy resulted in superior health benefits compared to immediate therapy with interferon until wait time exceeded 3-3.2 years. Such data can inform decision-making regarding treatment initiation for HCV as healthcare financing evolves.
authors.affiliation: Department of Medicine, Sections of Hospital Medicine and of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Pho
authors.affiliation: Center for Liver Disease, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Jensen
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: D O
authors.initials: DO
authors.lastname: Meltzer
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: A Y
authors.initials: AY
authors.lastname: Kim
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA.|Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
authors.forename: B P
authors.initials: BP
authors.lastname: Linas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage*; D020000:Decision Support Systems, Clinical; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: HCV; decision analysis; interferon sparing; treatment timing