TY - JOUR
T1 - Patient-important benefits of clearing the hepatitis C virus through treatment
T2 - a simulation model
AU - Innes, Hamish
AU - Goldberg, David
AU - Dusheiko, Geoffrey
AU - Hayes, Peter
AU - Mills, Peter R.
AU - Dillon, John F.
AU - Aspinall, Esther
AU - Barclay, Stephen T.
AU - Hutchinson, Sharon J.
N1 - Copyright © 2014. Published by Elsevier B.V.
PY - 2014
Y1 - 2014
N2 - 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.
© 2014 European Association for the Study of the Liver.
AB - 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.
© 2014 European Association for the Study of the Liver.
KW - Adverse effects
KW - Antiviral treatment
KW - Chronic hepatitis C
KW - Hepatitis C
KW - Markov model
KW - Patient-centred
KW - Patient-important outcomes
KW - Risk-benefit ratio
KW - Simulation model
UR - http://www.scopus.com/inward/record.url?scp=84894832895&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2014.01.020
DO - 10.1016/j.jhep.2014.01.020
M3 - Article
C2 - 24509410
SN - 0168-8278
VL - 60
SP - 1118
EP - 1126
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 6
ER -