Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus
New evidence shows treating HCV at 3 years old is projected to lead to improved clinical outcomes.
Children with perinatally acquired hepatitis C virus (HCV) are now eligible to receive direct-acting antivirals (DAAs), a highly effective treatment for HCV, as early as the age of 3. Despite existing studies demonstrating DAA’s high efficacy and tolerance among adults and children between the 3 and 12 years old, there has been low uptake due to concerns of cost and long-term health benefits. With emerging concerns of rising HCV infections among pregnant people in the United States, lead author and former CHERISH pilot grantee Megan R. Curtis, CHERISH investigator Benjamin Linas, and CHERISH Research Affiliates Rachel L. Epstein and Andrea L. Ciaranello, sought to evaluate the cost-effectiveness of providing DAA treatment at the age of 3.
Megan Rose Curtis, MD, MS
Lead author and former CHERISH pilot grantee
Curtis and colleagues developed a state-transition model and simulated a lifetime progression of perinatally acquired HCV in a cohort of 1,000 children. The treatment model included no treatment and initiation at 3 years, 6 years, 12 years, and 18 years old with an 8-week course of a DAA formulation approved for adults and children. The team defined effectiveness with sustained virologic response at 12 weeks and referenced HCV-related health care costs from a pharmacoeconomics evaluation.
Key Findings
- Treating HCV at 3 years old is projected to lead to improved clinical outcomes, compared to treating at 6 years old. As seen in the figure above, the number of individuals with HCV-related liver complications progressively increased when treatment is delayed.
- Starting treatment at 3 years old was cost saving. The projected discounted lifetime health care costs for initiating at 3 years old is $148,162, compared to $279,252 for receiving no treatment.
- The benefit of providing early HCV treatment increases as loss to follow-up rates increase. Considering the low linkage to treatment reported by prior studies, the sensitivity analyses conducted in this study demonstrate how early HCV treatment can mitigate issues of loss to follow-up for perinatally exposed infants.
Treating children with perinatally-acquired HCV, as early as the age of 3, could increase life expectancy and decrease healthcare expenditures.
This is the first health economic study that projected the costs and life expectancy outcomes of providing DAA treatment at the age of 3. Findings demonstrate that starting HCV treatment at 3 years costs less, is projected to improve health outcomes compared to deferring treatment, and addresses the gaps in care resulting from loss to follow-up. Current treatment guidelines approve and recommend DAA therapy for all children aged 3 years and older. To attain greater clinical outcomes and cost savings for treating perinatally acquired HCV, authors suggest increasing access to DAA and treating children for HCV at an early age.
Read the full study published in JAMA Pediatrics.