title: Real-world medical costs of antiviral therapy among patients with chronic HCV infection and advanced hepatic fibrosis.
abstract: OBJECTIVE
  Very potent direct acting antivirals for the treatment of chronic hepatitis C virus infection were recently introduced into daily clinical practice. Currently, treatment uptake is hampered by their high costs, eliciting prioritization of treatment. We aimed to evaluate the direct medical costs during interferon (IFN)-based antiviral treatment and the costs per sustained virological response (SVR) among patients with advanced hepatic fibrosis.
  
  
  METHODS
  This retrospective cohort study included all consecutive patients with chronic hepatitis C virus infection and biopsy-proven bridging fibrosis or cirrhosis (Ishak 4-6) treated with IFN-based regimens in five hepatology units of tertiary care centers in Europe and Canada. Direct medical costs, expressed in 2013 Euros, during therapy were assessed. The components of care were quantified by three distinct categories: treatment, safety/ monitoring, and complications. Cost per SVR was calculated by dividing the mean cost by the SVR rate.
  
  
  RESULTS
  In total, 672 interferon-based treatments administered to 455 patients were included. Total medical costs per patient were averaged to €14 559 (95% confidence interval [CI], €13 323-€15 836). The mean cost per SVR was €38 514 (95% CI, €35 244-€41 892). The costs per SVR were €26 105 (95% CI, €23 068-€29 296) for patients with a normal platelet count and €50 907 (95% CI, €44 151-€59 612) for patients with thrombocytopenia, with the costs per SVR of €74 961 (95% CI, €55 463-€103 541) among those patients with a platelet count below 100 * 109/L.
  
  
  CONCLUSIONS
  Because of the lower SVR rates, the cost per SVR of IFN-based treatment increased when patients with more advanced liver disease were treated. Additional costs of IFN-free therapy could be limited among these patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Raoel
authors.initials: R
authors.lastname: Maan
authors.affiliation: Institute for Medical Technology Assessment, Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Remziye
authors.initials: R
authors.lastname: Zaim
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Adriaan J
authors.initials: AJ
authors.lastname: van der Meer
authors.affiliation: Liver Centre, Toronto Western & General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jordan J
authors.initials: JJ
authors.lastname: Feld
authors.affiliation: Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
authors.affiliation: Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
authors.affiliation: Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Lammert
authors.affiliation: Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.affiliation: Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.|Liver Centre, Toronto Western & General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Harry LA
authors.initials: H
authors.lastname: Janssen
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Veldt
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: de Knegt
authors.affiliation: Institute for Medical Technology Assessment, Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002170:Canada; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000821:virology; D006801:Humans; D007372:Interferons / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000191:economics / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000072230:Sustained Virologic Response; D013921:Thrombocytopenia / Q000821:virology
chemical_list: D000998:Antiviral Agents; D007372:Interferons
keywords: antiviral therapy; chronic HCV infection; cirrhosis; medical cost; thrombocytopenia