Background: New directly acting antiviral (DAA) therapy for hepatitis C (HCV) offers
the potential for high cure rates in many patient groups previously considered
difficult-to-treat, including those HIV/HCV co-infected. The high price of these
medications is likely to limit access to treatment, at least in the short term. Early
treatment priority is likely to be given to those with advanced disease but a more
detailed understanding of the potential benefits in treating those with mild disease is
needed.
Objective: We hypothesised that successful HCV treatment within a co-infected
population with mild liver disease would lead to a reduction in the use and costs of
healthcare services in the 5 years following treatment completion.
Methods: We performed a retrospective cohort study of HIV/HCV co-infected
patients without evidence of fibrosis/ cirrhosis who received a course of HCV therapy
between 2004 and 2013. Detailed analysis of healthcare utilisation up to 5 years
following treatment for each patient using clinical and electronic records was used to
estimate healthcare costs.
Results: Sixty-three patients were investigated, of whom 48/63 (76.2%) achieved
sustained virological response 12 weeks following completion of therapy (SVR12).
Individuals achieving SVR12 incurred lower health utilisation costs (£5,000 perpatient)
compared to (£10,775 per-patient) non-SVR patients in the five years after
treatment.
Conclusion: Healthcare utilisation rates and costs in the immediate 5 years following
treatment were significantly higher in co-infected patients with mild disease that failed
to achieve SVR12. This data suggests additional value to achieving cure beyond the
prevention of complications of disease.