Value of Treating All Stages of Chronic Hepatitis C: A Comprehensive Review of Clinical and Economic Evidence
| Autor: | Patricia Arratibel Ugarte, Roberto Nuño Solinís, Yuri Sanchez Gonzalez, Ander Rojo |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Hepatitis C virus Clinical/economic burden Review Cochrane Library medicine.disease_cause 03 medical and health sciences Liver disease 0302 clinical medicine Quality of life medicine Decompensation 030212 general & internal medicine Intensive care medicine Prospective cohort study Sustained virologic response business.industry Incidence (epidemiology) virus diseases medicine.disease digestive system diseases Liver mortality/morbidity Infectious Diseases Hepatocellular carcinoma Immunology Extrahepatic manifestations 030211 gastroenterology & hepatology business |
| Zdroj: | Infectious Diseases and Therapy |
| ISSN: | 2193-8229 |
| Popis: | Introduction The goal of chronic hepatitis C (CHC) treatment is to achieve a sustained virologic response (SVR). The new generation of direct-acting antivirals (DAAs) offers 90–100% SVR rates. However, access to these treatments is generally limited to patients with advanced liver disease. The aim of this review is to provide an overview of the clinical and economic benefits of achieving SVR and to better understand the full value of CHC treatment in all stages of liver disease. Methods A comprehensive literature review was performed using the PubMed, Embase, and Cochrane library databases to identify articles examining the clinical, economic, and quality of life benefits associated with SVR. Articles were limited to those published in English language from January 2006 through January 2016. Inclusion criteria were (1) patients with CHC, (2) retrospective and prospective studies, (3) reporting of mortality, liver morbidity, extrahepatic manifestations (EHMs), and economic outcomes and, (4) availability of an abstract or full-text publication. Results Overall this review identified 354 studies involving more than 500,000 CHC patients worldwide. Evidence from 38 studies (n = 73,861) shows a significant mortality benefit of achieving SVR in patients with all stages of fibrosis. Long-term studies with follow-up of 5–12 years suggest that, particularly among non-cirrhotic patients, there is a significant decrease in mortality in SVR versus non-SVR groups. Ninety-nine studies conducted in 235,891 CHC patients in all stages of fibrosis show that SVR reduces liver-related mortality, incidence of hepatocellular carcinoma (HCC), and decompensation. A total of 233 studies show that chronic HCV infection is associated with several serious EHMs, some of which can have high mortality. Evidence from four modeling studies shows that delaying treatment to CHC patient populations could significantly increase mortality, morbidity, and medical costs. Conclusions There is a robust body of evidence demonstrating diverse sources of value from achieving SVR in all stages of liver disease. While access to treatment is generally limited to late-stage patients, less restrictive treatment strategies that target HCV eradication have the potential to abate the burdens of mortality, liver morbidity and extrahepatic manifestations, and the associated healthcare costs. Electronic supplementary material The online version of this article (doi:10.1007/s40121-016-0134-x) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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