Reduced healthcare utilization following successful hepatitis C virus treatment in HIV-co-infected patients with mild liver disease

Abstract

New direct-acting antivirals (DAA) for hepatitis C virus (HCV) infection have achieved high cure rates in many patient groups previously considered difficult-to-treat, including those HIV/HCV co-infected. The high price of these medications is likely to limit access to treatment, at least in the short term. Early treatment priority is likely to be given to those with advanced disease, but a more detailed understanding of the potential benefits in treating those with mild disease is needed. We hypothesized that successful HCV treatment within a co-infected population with mild liver disease would lead to a reduction in the use and costs of healthcare services in the 5 years following treatment completion. We performed a retrospective cohort study of HIV/HCV-co-infected patients without evidence of fibrosis/cirrhosis who received a course of HCV therapy between 2004 and 2013. Detailed analysis of healthcare utilization up to 5 years following treatment for each patient using clinical and electronic records was used to estimate healthcare costs. Sixty-three patients were investigated, of whom 48 of 63 (76.2%) achieved sustained virological response 12 weeks following completion of therapy (SVR12). Individuals achieving SVR12 incurred lower health utilization costs (£5,000 per-patient) compared to (£10 775 per-patient) non-SVR patients in the 5 years after treatment. Healthcare utilization rates and costs in the immediate 5 years following treatment were significantly higher in co-infected patients with mild disease that failed to achieve SVR12. These data suggest additional value to achieving cure beyond the prevention of complications of disease.

Keywords: HIV; healthcare utilization; hepatitis C.

Figure 1

Selection of study cohort. ^aAs of March 1 2014. HCV, hepatitis C virus; HIV, human immunodeficiency virus; SVR, sustained virological response.

Figure 2

Frequency of healthcare utilisation per patient‐year. Total follow‐up years: 182 SVR, 65 non‐SVR. Statistical significance detected at P < 0.05. HCV, hepatitis C virus; SVR, sustained virological response; USS, ultrasound scan; A&E, accident and emergency.