The long-term impact of hepatitis C infection in kidney transplantation in the pre-direct acting antiviral era

The causal link between chronic hepatitis C and glycometabolic alterations has been confirmed by much biochemical, clinical, and epidemiological research work, but what is still controversial is the long-term clinical impact of sustained virologic response (SVR) achieved by direct-acting antiviral agents (DAAs) on patients with type 2 diabetes mellitus (DM). The aim of this paper is to summarize the biochemical and clinical consequences to DM of DAA-based therapy for hepatitis C virus (HCV) infection. An electronic search of Embase, PubMed, MEDLINE, Ovid, and the Cochrane Database of Systematic Reviews was conducted for publications assessing whether clearance of HCV achieved by interferon (IFN)-free antiviral therapy determines significant changes in glycometabolic control and clinical outcomes of diabetic patients. A beneficial effect of SVR obtained by DAA therapy on DM prevention and the short-term outcome of glycometabolic alterations are acknowledged by most of the studies. Whether this effect is maintained over the long term with a significant clinical impact on diabetic and liver disease is still a matter of debate.

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The Promise of Direct-Acting Antiviral Therapies to Improve Care and Outcomes in Patients With Cancer Who Have Chronic Hepatitis C Infection

Journal of Oncology Practice ◽

10.1200/jop.19.00664 ◽

2019 ◽

Vol 15 (12) ◽

pp. 639-640 ◽

Cited By ~ 1

Author(s):

Yiannis Koullias ◽

Sarah P. Hammond

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Hepatitis C Infection ◽

Direct Acting Antiviral ◽

Antiviral Therapies ◽

Patients With Cancer ◽

Direct Acting

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Cost-Effectiveness Analysis of Direct-Acting Antiviral Agents for Occupational Hepatitis C Infections in Germany

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020440 ◽

2020 ◽

Vol 17 (2) ◽

pp. 440

Author(s):

Melanie Runge ◽

Magdalene Krensel ◽

Claudia Westermann ◽

Dominik Bindl ◽

Klaus Nagels ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Antiviral Agents ◽

Base Case ◽

German Statutory Accident Insurance ◽

Direct Acting Antiviral ◽

Life Years ◽

Direct Acting ◽

Direct Acting Antiviral Agents

Around 1% of the world’s population is infected with hepatitis C. The introduction of new direct-acting antiviral agents (DAAs) in 2014 has substantially improved hepatitis C treatment outcomes. Our objective was to evaluate the long-term cost effectiveness of DAAs in health care personnel (HP) with confirmed occupational diseases in Germany. A standardised database from a German statutory accident insurance was used to analyse the cost-effectiveness ratio for the DAA regimen in comparison with interferon-based triple therapies. Taking account of the clinical progression of the disease, a Markov model was applied to perform a base case analysis for a period of 20 years. The robustness of the results was determined using a univariate deterministic sensitivity analysis. The results show that treatment with DAAs is more expensive, but also more effective than triple therapies. The model also revealed that the loss of 3.23 life years can be averted per patient over the 20 years. Compared to triple therapies, DAA treatment leads to a higher sustained virologic response (SVR). Although this results in a decrease of costs in the long term, e.g., pension payments, DAA therapy will cause greater expense in the future due to the high costs of the drugs.

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