番茄社区

Treating hepatitis C virus (HCV) earlier in kids was associated with better lifetime clinical outcomes and lower healthcare costs compared with deferring treatment, a modeling study showed.

Projected life expectancy was longest when treatment started at age 3 (78.36 life years) and decreased with treatment deferral to age 6 (76.10), age 12 (75.99) and age 18 (75.46), reported Megan Rose Curtis, MD, MS, of Brigham and Women's Hospital in Boston, and colleagues.

Starting HCV treatment at age 3 was projected to cost $148,162 across a lifetime, which was less expensive than deferring treatment to age 6 ($164,292), 12 ($171,909), or 18 ($195,374), they wrote in .

The researchers also found in sensitivity analyses that the clinical benefits and cost savings tied to earlier treatment were significantly greater with increasing loss to follow-up.

Curtis told 番茄社区 that in cost-effectiveness analyses, interventions tend to be more effective but also more expensive.

"However, in this analysis, early treatment of children with HCV was projected to improve life expectancy and reduce costs," she said. "This implies that if we were to allocate resources towards extending treatment to all children with perinatally-acquired HCV infection that lives could be saved and overall healthcare expenditures could be reduced."

Earlier intervention was also projected to improve other clinical outcomes, the researchers found. In a model cohort of 1,000 children with perinatally-acquired HCV, treating at age 3 would prevent 89 cirrhosis cases, 27 cases of hepatocellular carcinoma (HCC), and 74 liver-related deaths compared with deferring treatment until age 6.

HCV prevalence among pregnant patients in the U.S. has risen 10-fold from 2000 to 2019, the researchers noted. Curtis thought about this trend in the context of the opioid epidemic.

"I began to wonder if HCV might represent a potential underappreciated impact of the opioid epidemic on maternal and child health," she said.

Recently, the CDC recommended that infants perinatally exposed to HCV should be RNA tested at age 2 to 6 months. Direct-acting antiviral (DAA) therapy was approved in 2021 to treat HCV in kids 3 and older. However, uptake for kids is low, due to concerns about both cost and long-term benefits.

Curtis said she believes "this study can offer helpful insights into that decision-making process, particularly considering concerns about loss-to-follow-up that might occur between a child becoming eligible for treatment at 3 years old and later ages."

For the simulated cohort of 1,000 children, authors modeled disease progression and costs of perinatally-acquired HCV from age 3 through death. They used published data about the natural history of pediatric HCV, the effectiveness of treatments, and healthcare costs. They modeled treatment with the pangenotypic DAA glecaprevir/pibrentasvir (Mavyret). Notable outcomes included life expectancy, average lifetime per-person healthcare costs, and clinical outcomes such as cases of cirrhosis, decompensated cirrhosis, and HCC.

Ultimately, authors concluded that "treating HCV at 3 years old costs less and leads to improved health outcomes compared to deferring treatment," they wrote.

Cynthia Gyamfi-Bannerman, MD, MS, department chair of obstetrics, gynecology, and reproductive sciences at UC San Diego Health, who wasn't involved in the study, said that based on these results, "pediatricians should encourage early treatment in affected children."

She also said that since the study was modeled statistically, only time will tell whether that modeling is correct.

Curtis and colleagues noted that their analysis was based on a few assumptions and had some limitations. For instance, they modeled that cirrhosis complications did not occur until adulthood because there are not population-level studies to inform clinical risks for kids. Also, there was insufficient pediatric data when informing some parameters, so they "assumed conditions that would bias away from the benefits of earlier treatment." Finally, they couldn't model indirect costs related to caregiving or mental healthcare.

Curtis said future research may include looking at the cost-effectiveness of treating HCV during pregnancy, which "may potentially prevent perinatal transmission and prevent the health complications and economic costs described in this analysis."

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