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The Effect of Shorter Treatment Regimens for Hepatitis C on Population Health and Under Fixed Budgets.

Publication ,  Journal Article
Morgan, JR; Kim, AY; Naggie, S; Linas, BP
Published in: Open Forum Infect Dis
January 2018

BACKGROUND: Direct acting antiviral hepatitis C virus (HCV) therapies are highly effective but costly. Wider adoption of an 8-week ledipasvir/sofosbuvir treatment regimen could result in significant savings, but may be less efficacious compared with a 12-week regimen. We evaluated outcomes under a constrained budget and cost-effectiveness of 8 vs 12 weeks of therapy in treatment-naïve, noncirrhotic, genotype 1 HCV-infected black and nonblack individuals and considered scenarios of IL28B and NS5A resistance testing to determine treatment duration in sensitivity analyses. METHODS: We developed a decision tree to use in conjunction with Monte Carlo simulation to investigate the cost-effectiveness of recommended treatment durations and the population health effect of these strategies given a constrained budget. Outcomes included the total number of individuals treated and attaining sustained virologic response (SVR) given a constrained budget and incremental cost-effectiveness ratios. RESULTS: We found that treating eligible (treatment-naïve, noncirrhotic, HCV-RNA <6 million copies) individuals with 8 weeks rather than 12 weeks of therapy was cost-effective and allowed for 50% more individuals to attain SVR given a constrained budget among both black and nonblack individuals, and our results suggested that NS5A resistance testing is cost-effective. CONCLUSIONS: Eight-week therapy provides good value, and wider adoption of shorter treatment could allow more individuals to attain SVR on the population level given a constrained budget. This analysis provides an evidence base to justify movement of the 8-week regimen to the preferred regimen list for appropriate patients in the HCV treatment guidelines and suggests expanding that recommendation to black patients in settings where cost and relapse trade-offs are considered.

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Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

January 2018

Volume

5

Issue

1

Start / End Page

ofx267

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences
 

Citation

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Chicago
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Morgan, J. R., Kim, A. Y., Naggie, S., & Linas, B. P. (2018). The Effect of Shorter Treatment Regimens for Hepatitis C on Population Health and Under Fixed Budgets. Open Forum Infect Dis, 5(1), ofx267. https://doi.org/10.1093/ofid/ofx267
Morgan, Jake R., Arthur Y. Kim, Susanna Naggie, and Benjamin P. Linas. “The Effect of Shorter Treatment Regimens for Hepatitis C on Population Health and Under Fixed Budgets.Open Forum Infect Dis 5, no. 1 (January 2018): ofx267. https://doi.org/10.1093/ofid/ofx267.
Morgan JR, Kim AY, Naggie S, Linas BP. The Effect of Shorter Treatment Regimens for Hepatitis C on Population Health and Under Fixed Budgets. Open Forum Infect Dis. 2018 Jan;5(1):ofx267.
Morgan, Jake R., et al. “The Effect of Shorter Treatment Regimens for Hepatitis C on Population Health and Under Fixed Budgets.Open Forum Infect Dis, vol. 5, no. 1, Jan. 2018, p. ofx267. Pubmed, doi:10.1093/ofid/ofx267.
Morgan JR, Kim AY, Naggie S, Linas BP. The Effect of Shorter Treatment Regimens for Hepatitis C on Population Health and Under Fixed Budgets. Open Forum Infect Dis. 2018 Jan;5(1):ofx267.
Journal cover image

Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

January 2018

Volume

5

Issue

1

Start / End Page

ofx267

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences