Featured Research

from universities, journals, and other organizations

Antiviral therapy during compensated cirrhosis most cost-effective approach

Date:
May 27, 2010
Source:
Wiley-Blackwell
Summary:
Researchers found that antiviral therapy during compensated cirrhosis, when compared with all other strategies, is the most cost-effective approach to treating patients with advanced liver disease due to hepatitis C (HCV) infection.

Researchers at the UCLA Medical Center found that antiviral therapy during compensated cirrhosis, when compared with all other strategies, is the most cost-effective approach to treating patients with advanced liver disease due to hepatitis C (HCV) infection.

Related Articles


HCV is generally treated once significant scarring has occurred but before patients develop advanced scarring, i.e. cirrhosis. The standard antiviral regimen used to treat HCV -- pegylated interferon and ribavirin (PEG/RBV) -- can cause harsh side effects and is considered by some medical professionals to be of uncertain benefit in patients with advanced liver disease.

Furthermore, HCV genotype 1, the type that afflicts most HCV patients, is least responsive to antiviral treatment. According to the HCV Advocate, genotype is the most important predictor of successful treatment response and also dictates the dose of ribavirin and length of therapy. People with genotype 1 have about a 50% chance of successful treatment and people with genotypes 2 or 3 have about a 70-90% chance of a successful treatment response. In addition, people with genotypes 2 or 3 are prescribed a lower dose of ribavirin than people with genotype 1.

Using a Markov model, the UCLA team set out to determine the most cost-effective timing for PEG/RBV therapy in patients with advanced liver disease infected with genotype 1 HCV by comparing treatment at different stages of advanced HCV disease over a 17-year period.

The study population of 4,000 patients was evenly divided into 4 different treatment strategies. The control group did not receive antiviral treatment. In the first treatment strategy, antiviral treatment was initiated in patients with compensated HCV cirrhosis. In the second treatment strategy, patients were treated only after development of decompensated liver disease. In the third treatment strategy, patients were treated only after development of histological evidence of advanced fibrosis due to HCV recurrence post-transplantation based on annual protocol graft biopsies. The duration of therapy was deemed to be 48 weeks. Response to treatment was classified as sustained viral response (SVR) or no SVR.

The UCLA researchers conclude that the model proves treatment of patients with compensated cirrhosis is the most cost-effective strategy, resulting in improved survival and decreased cost when compared with the other strategies. Treatment of patients with decompensated cirrhosis, or those with advanced graft fibrosis due to HCV recurrence, were also found to be cost-effective, but these patients derived less survival benefit at greater cost when compared to patients treated during compensated cirrhosis.

"This study provides pharmacoeconomic evidence in support of treating HCV in patients with compensated cirrhosis before progression to more advanced liver disease, said study leader Sammy Saab, M.D. "Given the results of this study we strongly recommend expeditious administration of antiviral therapy to patients with compensated cirrhosis before their disease advances."

Full details appear in the June issue of Liver Transplantation. In an editorial in this month's issue, Marina Berenguer, M.D., while agreeing with the recommendation by Saab and colleagues, identifies flaws with the study methodology, stating, "There are clear limitations in the use of these models, mostly due to the assumptions in which they are based. The lack of subgroup analysis, the use of some unproven assumptions, and the lack of multivariate sensitivity analysis are important limitations of the model in this very complex scenario where so many variables may play an important role. Physicians must decide whether the most cost-effective approach is the most appropriate one in each individual."


Story Source:

The above story is based on materials provided by Wiley-Blackwell. Note: Materials may be edited for content and length.


Journal Reference:

  1. Sammy Saab, Douglas R. Hunt, Michael A. Stone, Amy McClune, Myron J. Tong. Timing of hepatitis C antiviral therapy in patients with advanced liver disease: A decision analysis model. Liver Transplantation, 2010; DOI: 10.1002/lt.22072

Cite This Page:

Wiley-Blackwell. "Antiviral therapy during compensated cirrhosis most cost-effective approach." ScienceDaily. ScienceDaily, 27 May 2010. <www.sciencedaily.com/releases/2010/05/100527111339.htm>.
Wiley-Blackwell. (2010, May 27). Antiviral therapy during compensated cirrhosis most cost-effective approach. ScienceDaily. Retrieved October 25, 2014 from www.sciencedaily.com/releases/2010/05/100527111339.htm
Wiley-Blackwell. "Antiviral therapy during compensated cirrhosis most cost-effective approach." ScienceDaily. www.sciencedaily.com/releases/2010/05/100527111339.htm (accessed October 25, 2014).

Share This



More Health & Medicine News

Saturday, October 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

IKEA Desk Converts From Standing to Sitting With One Button

IKEA Desk Converts From Standing to Sitting With One Button

Buzz60 (Oct. 24, 2014) IKEA is out with a new convertible desk that can convert from a sitting desk to a standing one with just the push of a button. Jen Markham explains. Video provided by Buzz60
Powered by NewsLook.com
Ebola Protective Suits Being Made in China

Ebola Protective Suits Being Made in China

AFP (Oct. 24, 2014) A factory in China is busy making Ebola protective suits for healthcare workers and others fighting the spread of the virus. Duration: 00:38 Video provided by AFP
Powered by NewsLook.com
WHO: Millions of Ebola Vaccine Doses by 2015

WHO: Millions of Ebola Vaccine Doses by 2015

AP (Oct. 24, 2014) The World Health Organization said on Friday that millions of doses of two experimental Ebola vaccines could be ready for use in 2015 and five more experimental vaccines would start being tested in March. (Oct. 24) Video provided by AP
Powered by NewsLook.com
Doctor in NYC Quarantined With Ebola

Doctor in NYC Quarantined With Ebola

AP (Oct. 24, 2014) An emergency room doctor who recently returned to the city after treating Ebola patients in West Africa has tested positive for the virus. He's quarantined in a hospital. (Oct. 24) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins