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Exp Clin Transplant. 2016 Feb;14(1):66-71. doi: 10.6002/ect.2015.0069. Epub 2015 Nov 17.

Timing of Antiviral Therapy in Candidates for Liver Transplant for Hepatitis C and Hepatocellular Carcinoma.

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1
From the Departments of Medicine and Surgery, University of California at Los Angeles, Los Angeles, USA.

Abstract

OBJECTIVES:

Hepatitis C virus infection is the most common underlying reason for hepatocellular carcinoma and indication for liver transplant. The increased availability of non-interferon-based therapy has expanded the number of treatment-eligible patients.

MATERIALS AND METHODS:

We used a decision analysis model to compare 2 strategies of treating hepatitis C virus. Included patients were followed for 1 year after liver transplant. The probabilities and costs were obtained from a literature review, an expert panel, and our institution's experience. Sensitivity analyses were performed on all variables.

RESULTS:

Our model demonstrated that it would be less costly to treat patients after liver transplant than to treat patients while they wait for transplant. When we compared baseline values, the cost difference between the 2 strategies was $25,011 per patient and $41,535 per sustained viral response. Overall survival was 60.1% for both strategies. Our model was robust across most of the variables tested in the sensitivity analysis.

CONCLUSIONS:

Our results indicated that there is no substantial pharmacoeconomic or survival advantage of treating hepatitis C virus in patients with compensated cirrhosis and hepatocellular carcinoma before liver transplant versus after transplant.

PMID:
26581477
DOI:
10.6002/ect.2015.0069
[Indexed for MEDLINE]
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