Early DAA treatment cost-effective for kids with HCV

In children with hepatitis C virus (HCV) infection, early treatment with direct-acting antivirals (DAA) is a more cost-effective option than delaying to adulthood, leading to averted cases of cirrhosis, malignancies, and deaths, a new study has found.

Researchers generated a state-transition model of chronic HCV, comparing DAA treatment initiated at 6 years of age vs delaying medication until age 18 years. Outcomes included the expected quality adjusted life-years (QALYs) and medical costs in CAD$, compared between the two scenarios. Input data were retrieved from existing literature and government statistics.

Of children who were treated early, 0.1 percent eventually developed cirrhosis after 20 years. In the same span of time, 0.02 percent died diagnosed with decompensated cirrhosis or hepatocellular carcinoma. In comparison, 3.4 percent and 0.45 percent of children with deferred treatment met the respective outcomes.

In absolute terms, early treatment in 10,000 children could avert 330 cases of cirrhosis, 18 of hepatocellular carcinoma, and 43 of liver-related deaths. In turn, such an impact would yield a gain of 0.63 QALYs.

In the base case economic model, early treatment with DAAs resulted in an additional 7,975 CAD$ cost. The additional expense was not completely offset by savings from preventing late-stage disease, though the resulting incremental cost-effectiveness ratio (12,687 CAD$ per QALY gained) was deemed effective under a 50,000 CAD$ per QALY gained threshold.

“These results therefore support clinical and health policies that broaden treatment access for HCV infection to very young children, which is essential to achieve the global elimination of HCV,” the researchers said.