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Antiviral therapy during compensated cirrhosis most cost-effective approach
Date:5/27/2010

reated only after development of decompensated liver disease. In the third treatment strategy, patients were treated only after development of histological evidence of advanced fibrosis due to HCV recurrence post-transplantation based on annual protocol graft biopsies. The duration of therapy was deemed to be 48 weeks. Response to treatment was classified as sustained viral response (SVR) or no SVR.

The UCLA researchers conclude that the model proves treatment of patients with compensated cirrhosis is the most cost-effective strategy, resulting in improved survival and decreased cost when compared with the other strategies. Treatment of patients with decompensated cirrhosis, or those with advanced graft fibrosis due to HCV recurrence, were also found to be cost-effective, but these patients derived less survival benefit at greater cost when compared to patients treated during compensated cirrhosis.

"This study provides pharmacoeconomic evidence in support of treating HCV in patients with compensated cirrhosis before progression to more advanced liver disease, said study leader Sammy Saab, M.D. "Given the results of this study we strongly recommend expeditious administration of antiviral therapy to patients with compensated cirrhosis before their disease advances."

In an editorial in this month's issue, Marina Berenguer, M.D., while agreeing with the recommendation by Saab and colleagues, identifies flaws with the study methodology, stating, "There are clear limitations in the use of these models, mostly due to the assumptions in which they are based. The lack of subgroup analysis, the use of some unproven assumptions, and the lack of multivariate sensitivity analysis are important limitations of the model in this very complex scenario where so many variables may play an important role. Physicians must decide whether the most cost-effective approach is the most appropriate one in each individual."


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Contact: Dawn Peters
medicalnews@wiley.com
781-388-8408
Wiley-Blackwell
Source:Eurekalert

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