2395 Treating Acute Hepatitis C Virus Infections: Is It Cost Effective?

Abstract

INTRODUCTION: One- fourth of acute HCV patients spontaneously clear the virus. Direct antiviral agents(DAA) decreased the duration of treatment, cost-effective, and reduce the transmission risk. Of 2 cases we present here, one achieved SVR with DAA and another cleared the virus spontaneously. CASE DESCRIPTION/METHODS: 1) 51 y/o F presented with RUQ pain & jaundice. Labs: AST 1633, ALT 2214, ALP 345, T.bili 6.4. Imaging: no biliary obstruction. Acute hepatitis panel was positive for HCV antibodies. These were negative 3 months ago. Genotype was 1a and viral load was 1,000,000. Biopsy showed acute hepatitis with lobular and portal inflammation. She was treated with ledipasvir 90 mg/sofosbuvir 400 mg daily for 12 weeks and SVR was achieved. 2) 29 y/o M presented with RUQ and jaundice. He is an IVDU. Labs: AST 1338, ALT 2921 T bili at 14.8 and ALP 244. Imaging: negative for biliary obstruction. He was tested positive for HCV RNA titers . His prior HCV Ab was negative 2 weeks ago.Genotype was 1a and viral titers were1,894,692. He was given Oxcarbazapine recently. Biopsy showed lobular inflammation with hepatocyte necrosis, eosinophils, granulomas and portal inflammation consistent with acute hepatitis. Though the presence of the eosinophils and granulomas suggest Oxcarbazepine induced liver injury, the marked hepatocyte injury coincides with acute HCV. He cleared the HCV spontaneously after 4 months. DISCUSSION: Liver tests and HCV RNA monitoring for 6 months is recommended for acute HCV treatment. when the quality adjusted life years (QALY) and costs were measured in a microsimulation model, treatment of acute HCV,when compared to chronic HCV in non- high-risk behaviors, QALY increased by 0.02. The increased cost was 483 dollars with a resulted incremental cost effectiveness ratio (ICER) of $19,9991 per QALY, demonstrating that this treatment is cost effective. In high risk patients the QALY increased by 0.03 and decreased costs up to $3,655, substantiating this as a cost saving outcome. Although more studies are needed to demonstrate the effectiveness of DAAS,this particular study seemed to be promising.