Direct‐acting antivirals combination for elderly patients with chronic hepatitis C: A cost‐effectiveness analysis

• DOI: 10.1111/liv.13339
• Publication Date: 2016-12-10T13:53:10Z
• Authors: Antonio Ciaccio; Paolo A. Cortesi; Giuseppe Bellelli; Matteo Rota; Sara Conti; Stefano Okolicsanyi; Monica Rota; Giancarlo Cesana; Lorenzo G. Mantovani; Giorgio Annoni; Mario Strazzabosco
• Keywords: Hepatitis C

Abstract Background Chronic hepatitis C ( CHC ) has been undertreated among elderly patients. Interferon‐free treatment represents an opportunity for these The aim of this study was to assess the cost‐effectiveness directly acting antivirals DAA s) in Methods A Markov model natural history built. This focuses on patients older than 65 years, stratified according genotype (1/4, 2 and 3), liver fibrosis METAVIR F1 F4), age frailty phenotype (robust, pre‐frail frail). s combination vs no simulated each theoretical population, assessing life quality‐adjusted years QALY s), costs, incremental ratios ICER a lifetime time horizon by Healthcare System perspective. Results Incremental ratio increased with status all stages. For robust F3 F4 remained below willingness‐to‐pay threshold WTP 40 000€/ up 75 86 respectively, depending drug price sustained virological response probability (sensitivity analysis). Notably, frail subjects more sensitive non‐liver‐related mortality rate. In F2 patients, were only 77 old, wide variability phenotypes. Conclusions Cost‐effectiveness is solid those advanced fibrosis, but it depends strongly age, particularly milder Accurate assessment clinical variables, including frailty, necessary allocate limited resources special population.