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Scotland sees drop in decompensated cirrhosis rates in patients with Hep C

Scotland has seen a significant decrease in the rate of decompensated cirrhosis among patients with chronic HCV infection in the first 3 years since the introduction of direct-acting antivirals (DAAs).

Data presented at International Liver Congress in France last week show that after the introduction of DAAs in April 2014, 4800 people in Scotland had initiated HCV therapy by March 2017. Of these, 83% were treated with DAAs and 94% achieved sustained viral response. The scale-up of therapy, compared with the 3 preceding years, was associated with a 29% and 39% reduction in first-time presentations for decompensated cirrhosis among those previously diagnosed with chronic HCV and those with chronic HCV at the time of admission, respectively.

A second Scottish study presented at the conference also showed that delaying HCV treatment until more advanced stages of fibrosis results in increased lifetime risks of liver-related morbidity and mortality, greater lifetime costs, and lower quality-adjusted life years (QALYs), regardless of genotype.

Using a health state transition model of the natural history of HCV, lower rates of liver decompensation, hepatocellular carcinoma, liver transplantation and liver-related death were predicted when treatment was initiated in mild vs compensated cirrhosis disease. While only liver-related complications were considered, early vs delayed treatment resulted in lower lifetime costs and greater lifetime QALYs.

The authors say the results show that treatment at earlier fibrosis stages is a cost-effective and dominant strategy compared with treatment at later stages.


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