There are reports of pre-transplant sofosbuvir (SOF) plus ribavirin being effective in preventing recurrent 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 to 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 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 SVR reached after LT. This article is protected by copyright. All rights reserved.

Cost-effectiveness of Pre-Transplant Sofosbuvir for Preventing Recurrent HCV Infection after Liver Transplantation.

Vitale Alessandro;Spolverato Gaya;Burra Patrizia;Toniutto Pierluigi;Russo Francesco Paolo;Cillo Umberto;Angeli P;Fagiuoli Stefano
2015

Abstract

There are reports of pre-transplant sofosbuvir (SOF) plus ribavirin being effective in preventing recurrent 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 to 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 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 SVR reached after LT. This article is protected by copyright. All rights reserved.
File in questo prodotto:
Non ci sono file associati a questo prodotto.
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11577/3143135
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 7
  • ???jsp.display-item.citation.isi??? 7
social impact