Background & Aims
Given an appreciable risk of adverse-effects, current therapies for chronic hepatitis
C virus (HCV) infection pose a dilemma to patients. We explored, via simulation modelling,
patient-important benefits of attaining a sustained viral response (SVR).
Methods
We created the HCV Individualised Treatment-decision model (the HIT-model) to simulate,
on a per patient basis, the lifetime course of HCV-related liver disease according
to two distinct scenarios: (i) SVR attained, and (ii) SVR not attained. Then, for
each model subject, the course of liver disease under these alternative scenarios
was compared. The benefit of SVR was considered in terms of two patient-important
outcomes: (1) the percent-probability that SVR confers additional life-years, and
(2) the percent-probability that SVR confers additional healthy life-years, where
“healthy” refers to years spent in compensated disease states (i.e., the avoidance
of liver failure).
Results
The benefit of SVR varied strikingly. It was lowest for patients aged 60 years with initially mild fibrosis; 1.6% (95% CI: 0.8–2.7) and 2.9% (95% CI: 1.5–4.7)
probability of gaining life-years and healthy life-years, respectively. Whereas it
was highest for patients with initially compensated cirrhosis aged 30 years; 57.9% (95% CI: 46.0–69.0) and 67.1% (95% CI: 54.1–78.2) probability of gaining
life-years and healthy life-years, respectively.
Conclusions
For older patients with less advanced liver fibrosis, SVR is less likely to confer
benefit when measured in terms of averting liver failure and premature death. These
data have important implications. Foremost, it may inform the contemporary patient
dilemma of immediate treatment with existing therapies (that have poor adverse effect
profiles) vs. awaiting future regimens that promise better tolerability.
Abbreviations:
HCV (Hepatitis C virus), SVR (Sustained viral response), HIT model (Hepatitis-C Individual-based Treatment-decision model), HCC (Hepatocellular Carcinoma), NSS (Number need to attain SVR), NNT (Number needed to treat), SA (Sensitivity analysis)Keywords
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Article info
Publication history
Published online: February 06, 2014
Accepted:
January 27,
2014
Received in revised form:
January 20,
2014
Received:
August 7,
2013
Identification
Copyright
© 2014 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
