title: Are targeted treatment recommendations in chronic hepatitis C tailored to diagnostic methods of fibrosis?
abstract: The progression of chronic HCV infection varies significantly depending on patient characteristics. The goal of the present study was to evaluate the consequences of targeted and universal therapy for HCV-related morbidity-mortality based on the use of non-invasive diagnostic tests in France, Italy and the UK.
  
  
  
  A country-specific Markov model was used to predict clinical outcomes in patients with chronic HCV mono-infection over 5years. Therapeutic strategies used in the three countries analysed: no treatment, targeted therapy based on stage of fibrosis (F2- or F3-scenario), treatment regardless of stage of fibrosis (universal analysis), base-case analysis and yearly assessments.
  
  
  
  Universal therapy is the most effective strategy and reduced the 5-year incidence of cirrhosis by 12.0-17.7, liver complications by 4.2-5.3 and liver deaths by 3.7-4.7, vs. no treatment. In base-case analysis, the F2-scenario using FibroScan or patented blood biomarkers reduces the 5-year incidence of cirrhosis by 2.7-4.0, liver complications by 3.5-3.7 and liver deaths by 3.3-3.7, vs. no treatment. The results of the F3-scenario are poor for the incidence of cirrhosis, and moderately effective for the liver complications. The alternative analysis with a yearly assessment of fibrosis improves the impact of targeted therapy.
  
  
  
  By quantifying the impact of different strategies of targeted therapy and universal therapy, this study could help health agencies and experts to draft therapeutic guidelines for HCV-related fibrosis.
  
  
  
  The impact of different treatment strategies was evaluated in three countries, France, Italy and UK, using a mathematical model. This analysis showed that: i) A prioritization strategy of HCV treatment for patients with advanced disease would decrease the overall impact of treatment on morbidity and mortality; and ii) A strategy initiating HCV treatment to all would already show a benefit in reducing 5-year morbidity and mortality.
authors.affiliation: Inserm, LIRIC-UMR995, Lille, France; Univ Lille, Lille, France; Inserm, IAME, UMR 1137, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: sylvie.burban@inserm.fr.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deuffic-Burban
authors.affiliation: CHU d'Angers Service d'Hépato-Gastroentérologie, Angers, France; HIFIH, UPRES 3859, SFR 4208, Univ LUNAM, Angers, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
authors.affiliation: CHU de Grenoble Clinique Universitaire d'Hépato-Gastroentérologie, Pôle Digidune, Grenoble, France; Inserm U823, IAPC Institut Albert Bonniot, Grenoble, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.affiliation: Inserm, IAME, UMR 1137, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Service de maladies Infectieuses et tropicales, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm U773, Univ Paris Diderot, Sorbonne Paris Cité, Clichy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Castera
authors.affiliation: Inserm, LIRIC-UMR995, Lille, France; Univ Lille, Lille, France; CHRU Lille, Hôpital Huriez, Service des Maladies de l'Appareil Digestif et de la Nutrition, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data*; D008875:Middle Aged; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents
keywords: Cirrhosis; Interferon-free therapy; Liver complications; Liver deaths; Markov model; Non-invasive markers of fibrosis; Targeted therapy; Therapeutic strategy; Universal therapy