title: Treatment of Chronic Hepatitis C in the Aged - Does It Impact Life Expectancy? A Decision Analysis.
abstract: OBJECTIVE
  Recent studies have demonstrated that the efficacy of interferon-free direct-acting antiviral agents (DAAs) in patients over 70 is similar to that of younger age groups. Evidence continues to mount that life expectancy (LE) increases with successful treatment of hepatitis C (HCV) patients with advanced fibrosis. The evidence in older people is more limited. Our aim was to estimate the life year (LY) and quality-adjusted life year (QALY) gained by treatment of naïve patients with HCV as a function of patient's age and fibrosis stage.
  
  
  METHODS
  We constructed a Markov model of HCV progression toward advanced liver disease. The primary outcome was LY and QALY saved. The model and the sustained virological response of HCV infected subjects treated with a fixed-dose combination of the NS5B polymerase inhibitor Sofosbuvir and the NS5A replication complex inhibitor Ledipasvir were based on the published literature and expert opinion.
  
  
  RESULTS
  Generally, both the number of LY gained and QALY gained gradually decreased with advancing age but the rate of decline was slower with more advanced fibrosis stage. For patients with fibrosis stage F1, F2 and F3, LY gained dropped below six months if treated by the age of 55, 65 or 70 years, respectively, while for a patient with fibrosis stage F4, the gain was one LY if treated by the age of 75. The QALY gained for treated over untreated elderly were reasonably high even for those treated at early fibrosis stage.
  
  
  CONCLUSIONS
  There is a significant life expectancy benefit to HCV treatment in patients up to age 75 with advanced-stage fibrosis.
authors.affiliation: Institute of Gastroenterology and Hepatology, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Maor
authors.affiliation: Institute of Gastroenterology and Hepatology, Kaplan Medical Center, Rehovot, Israel.|Department of Internal Medicine C, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Stephen D H
authors.initials: SD
authors.lastname: Malnick
authors.affiliation: Institute of Gastroenterology and Hepatology, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Melzer
authors.affiliation: Faculty of Management and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Leshno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D003661:Decision Support Techniques; D018450:Disease Progression; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D000069474:Sofosbuvir; D014542:Uridine Monophosphate / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D001562:Benzimidazoles; D005449:Fluorenes; C000595958:ledipasvir, sofosbuvir drug combination; D014542:Uridine Monophosphate; D000069474:Sofosbuvir