title: Timing of Antiviral Therapy in Candidates for Liver Transplant for Hepatitis C and Hepatocellular Carcinoma.
abstract: OBJECTIVE
  Hepatitis C virus infection is the most common underlying reason for hepatocellular carcinoma and indication for liver transplant. The increased availability of non-interferon-based therapy has expanded the number of treatment-eligible patients.
  
  
  METHODS
  We used a decision analysis model to compare 2 strategies of treating hepatitis C virus. Included patients were followed for 1 year after liver transplant. The probabilities and costs were obtained from a literature review, an expert panel, and our institution's experience. Sensitivity analyses were performed on all variables.
  
  
  RESULTS
  Our model demonstrated that it would be less costly to treat patients after liver transplant than to treat patients while they wait for transplant. When we compared baseline values, the cost difference between the 2 strategies was $25,011 per patient and $41,535 per sustained viral response. Overall survival was 60.1% for both strategies. Our model was robust across most of the variables tested in the sensitivity analysis.
  
  
  CONCLUSIONS
  Our results indicated that there is no substantial pharmacoeconomic or survival advantage of treating hepatitis C virus in patients with compensated cirrhosis and hepatocellular carcinoma before liver transplant versus after transplant.
authors.affiliation: From the Departments of Medicine and Surgery, University of California at Los Angeles, Los Angeles, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Melissa
authors.initials: M
authors.lastname: Jimenez
authors.forename: Tiffany
authors.initials: T
authors.lastname: Fong
authors.forename: Crystal
authors.initials: C
authors.lastname: Wu
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Kabany
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Tong
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000401:mortality / Q000601:surgery* / Q000821:virology; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D016527:Drug Costs; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D018803:Models, Economic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D000998:Antiviral Agents