Patient-important benefits of clearing the hepatitis C virus through treatment: a simulation model

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 - https://www.scopus.com/pages/publications/84901237436

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 -