HCV: all-oral DAA regimens slash risk for HCC, DCC

  • Park H & al.
  • Hepatology
  • 5 Oct 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • All-oral direct-acting antiviral (DAA) treatment for HCV is associated with decreased risk for development of hepatocellular carcinoma (HCC) and decompensated cirrhosis (DCC).
  • Benefits in cirrhotic patients have favorable economic effect.

Why this matters

  • Study provides real-world evidence on US clinical and economic benefit in the era of second-generation DAAs.

Study design

  • Study of 26,105 patients with newly diagnosed HCV in the Truven Health MarketScan database (2012-2016).
  • Outcomes compared with all-oral DAA therapy (30%) vs no treatment (70%).
  • Economic analysis of propensity-matched cohort (n=8064; 8.5% cirrhotic) with 12-month follow-up.
  • Funding: None disclosed.      

Key results

  • Cirrhotic patients (n=2157: 2.6% and 6.1% developed HCC and DCC, respectively):
    • DAA therapy was tied to 72% lower odds of HCC (HR=0.28; 95% CI, 0.15-0.52) and 62% lower risk for DCC (HR=0.38; 95% CI, 0.26-0.56).
  • Noncirrhotic patients (n=23,948: 0.5% and 1.3% developed HCC and DCC, respectively):
    • DAA therapy was associated with 57% lower odds of HCC (HR=0.43; 95% CI, 0.26-0.71) and 58% reduced risk for DCC (HR=0.42; 95% CI, 0.30-0.58).
  • Economic analysis:
    • DAA treatment in cirrhotic patients resulted in significantly lower mean 1-year adjusted liver-related costs ($1749 vs $4575; P<.001 and all-cause medical costs vs p>

Limitations

  • Retrospective design, reliance on ICD codes.
  • Nontreatment reasons not captured.

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