Abstract
Background and AimsRecent studies have demonstrated that the efficacy of interferon-free direct-acting antiviral agents (DAAs) in patients over 70 is similar to that of younger age groups. Evidence continues to mount that life expectancy (LE) increases with successful treatment of hepatitis C (HCV) patients with advanced fibrosis. The evidence in older people is more limited. Our aim was to estimate the life year (LY) and quality-adjusted life year (QALY) gained by treatment of naïve patients with HCV as a function of patient's age and fibrosis stage.MethodsWe constructed a Markov model of HCV progression toward advanced liver disease. The primary outcome was LY and QALY saved. The model and the sustained virological response of HCV infected subjects treated with a fixed-dose combination of the NS5B polymerase inhibitor Sofosbuvir and the NS5A replication complex inhibitor Ledipasvir were based on the published literature and expert opinion.ResultsGenerally, both the number of LY gained and QALY gained gradually decreased with advancing age but the rate of decline was slower with more advanced fibrosis stage. For patients with fibrosis stage F1, F2 and F3, LY gained dropped below six months if treated by the age of 55, 65 or 70 years, respectively, while for a patient with fibrosis stage F4, the gain was one LY if treated by the age of 75. The QALY gained for treated over untreated elderly were reasonably high even for those treated at early fibrosis stage.ConclusionsThere is a significant life expectancy benefit to HCV treatment in patients up to age 75 with advanced-stage fibrosis.
Highlights
Hepatitis C (HCV) affects about 170 million people worldwide and is a leading cause of cirrhosis and hepatic insufficiency, and a reason for liver transplantation
The model and the sustained virological response of Hepatitis C virus (HCV) infected subjects treated with a fixed-dose combination of the NS5B polymerase inhibitor Sofosbuvir and the NS5A replication complex inhibitor Ledipasvir were based on the published literature and expert opinion
Both the number of life year (LY) gained and quality-adjusted life year (QALY) gained gradually decreased with advancing age but the rate of decline was slower with more advanced fibrosis stage
Summary
Hepatitis C (HCV) affects about 170 million people worldwide and is a leading cause of cirrhosis and hepatic insufficiency, and a reason for liver transplantation. The U.S Centers for Disease Control and Prevention (CDC) and the U.S Preventive Services Task Force (USPSTF) recently issued their recommendation for one-time testing of adults born during 1945–1965 (baby boomers) for HCV without prior ascertainment of HCV risk [1]. These recommendations, which are based on the finding that the members of this cohort, many of whom are approaching 70, account for 76.5% of those with HCV antibodies in the US [1], led to the development of a multicohort natural history model for predicting disease outcomes and benefits of therapy [2]. As this age group overlaps the 1945–1965 birth cohorts, more advanced HCV can be seen as becoming a serious problem for the elderly
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