Are targeted treatment recommendations in chronic hepatitis C tailored to diagnostic methods of fibrosis?

J Hepatol. 2017 Feb;66(2):304-312. doi: 10.1016/j.jhep.2016.10.006. Epub 2016 Oct 13.

Abstract

Background & aims: The progression of chronic HCV infection varies significantly depending on patient characteristics. The goal of the present study was to evaluate the consequences of targeted and universal therapy for HCV-related morbidity-mortality based on the use of non-invasive diagnostic tests in France, Italy and the UK.

Methods: A country-specific Markov model was used to predict clinical outcomes in patients with chronic HCV mono-infection over 5years. Therapeutic strategies used in the three countries analysed: no treatment, targeted therapy based on stage of fibrosis (F2- or F3-scenario), treatment regardless of stage of fibrosis (universal analysis), base-case analysis and yearly assessments.

Results: Universal therapy is the most effective strategy and reduced the 5-year incidence of cirrhosis by 12.0-17.7, liver complications by 4.2-5.3 and liver deaths by 3.7-4.7, vs. no treatment. In base-case analysis, the F2-scenario using FibroScan or patented blood biomarkers reduces the 5-year incidence of cirrhosis by 2.7-4.0, liver complications by 3.5-3.7 and liver deaths by 3.3-3.7, vs. no treatment. The results of the F3-scenario are poor for the incidence of cirrhosis, and moderately effective for the liver complications. The alternative analysis with a yearly assessment of fibrosis improves the impact of targeted therapy.

Conclusion: By quantifying the impact of different strategies of targeted therapy and universal therapy, this study could help health agencies and experts to draft therapeutic guidelines for HCV-related fibrosis.

Lay summary: The impact of different treatment strategies was evaluated in three countries, France, Italy and UK, using a mathematical model. This analysis showed that: i) A prioritization strategy of HCV treatment for patients with advanced disease would decrease the overall impact of treatment on morbidity and mortality; and ii) A strategy initiating HCV treatment to all would already show a benefit in reducing 5-year morbidity and mortality.

Keywords: Cirrhosis; Interferon-free therapy; Liver complications; Liver deaths; Markov model; Non-invasive markers of fibrosis; Targeted therapy; Therapeutic strategy; Universal therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / therapeutic use
  • Carcinoma, Hepatocellular* / epidemiology
  • Carcinoma, Hepatocellular* / etiology
  • Carcinoma, Hepatocellular* / pathology
  • Disease Progression
  • Female
  • France / epidemiology
  • Hepatitis C, Chronic* / complications
  • Hepatitis C, Chronic* / diagnosis
  • Hepatitis C, Chronic* / drug therapy
  • Hepatitis C, Chronic* / epidemiology
  • Humans
  • Italy / epidemiology
  • Liver Cirrhosis* / diagnosis
  • Liver Cirrhosis* / epidemiology
  • Liver Cirrhosis* / etiology
  • Liver Neoplasms* / epidemiology
  • Liver Neoplasms* / etiology
  • Liver Neoplasms* / pathology
  • Male
  • Medication Therapy Management / statistics & numerical data*
  • Middle Aged
  • Treatment Outcome
  • United Kingdom / epidemiology

Substances

  • Antiviral Agents