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Transpl Int. 2015 Sep;28(9):1055-65. doi: 10.1111/tri.12591. Epub 2015 Apr 30.

Cost-effectiveness of pretransplant sofosbuvir for preventing recurrent hepatitis C virus infection after liver transplantation.

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University Hospital of Padua, Padua, Italy.
North Italy Transplant program, Fond. IRCCS Ca' Granda OMP, Milan, Italy.
Hepatology and Gastroenterology, Ospedale Niguarda Ca' Granda, Milan, Italy.
Gastroenterology Unit, Ospedale Maggiore Policlinico, Milan, Italy.
Liver Transplantation Unit, Ancona Hospital, Ancona, Italy.
Liver Unit, Tor Vergata University, Rome, Italy.
IRCCS San Martino, IST Genova, Genova, Italy.
Medical Liver Transplant Unit, University of Udine, Udine, Italy.
Liver Transplantation, IRCCS INT, Milan, Italy.
Liver Transplantation Unit, Verona Hospital, Verona, Italy.
Gastroenterology and Transplant Hepatology, Ospedale Papa Giovanni XXIII, Bergamo, Italy.


There are reports of pretransplant sofosbuvir (SOF) plus ribavirin being effective in preventing recurrent hepatitis C virus (HCV) infection after liver transplantation (LT). The aim of this study was to assess the cost-effectiveness of this strategy in the area served by the North Italy Transplant program. We retrospectively assessed the impact of HCV infection on post-LT survival in 2376 consecutive adult patients (MELD ≤ 25, unknown genotype, period 2004-2009) and the prevalence costs of conventional standard of care (SOC) antiviral therapy (pegylated interferon plus ribavirin) after LT. A Markov model was developed to compare two strategies: 12-24 weeks of SOF+ ribavirin for pre-LT anti-HCV treatment versus on-demand post-LT SOC antiviral therapy. Among the 1794 patients undergoing LT, 860 (48%) were HCV+ and 50% of them were given SOC therapy after LT (mean cost of drugs and adverse effect management = 14,421€ per patient). HCV etiology had a strong impact on post-LT survival (hazard ratio = 1.59, 95% CI = 1.22-2.09, P = 0.0007). After Monte Carlo simulation, pre-LT SOF therapy showed a median survival benefit of 1.5 quality-adjusted life years and an Incremental cost-effectiveness ratio (ICER) of 30,663€/QALY, proving cost-effective in our particular Italian scenario. The costs of SOF therapy, sustained viral response rate 12 weeks after LT, and recipient's age were the main ICER predictors at multivariate analysis. This study proposes a dynamic model based on real-life data from northern Italy for adjusting the costs of pre-LT direct-acting antiviral therapies to the actual sustained virological response reached after LT.


cost-effectiveness analysis; hepatitis C virus infection; liver transplantation; recurrent HCV; sofosbuvir

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