The Best Time To Treat Children with Hepatitis C And Cost Considerations

E Greenaway et al. J Pediatr 2021; 230: 38-45. Treatment of Chronic Hepatitis C in Young Children Reduces Adverse Outcomes and Is Cost-Effective Compared with Deferring Treatment to Adulthood

Related editorial: N Rodriguez-Baez. J Pediatr 2021; 230: 9-10. Full text: Hepatitis C in Young Children: To Treat or Not to Treat – Is It Cost-Effective?

In this study, the authors used a state-transition model to assess cost-effectiveness of hepatitis C virus (HCV) infection in children; the model treated a hypothetical cohort of 10,000 children with chronic HCV at age 6 years with combination therapy of sofosbuvir/ledipasvir for 12 weeks vs deferring treatment until 18 years of age.

Key findings:

  • The incremental cost effectiveness of early treatment of young children was $12 690 per QALY gained after 20 years, which is considered cost effective compared with deferred treatment.
  • The authors note that if the cost of DAA medications dropped by 60%, then early treatment would not be more cost effective.
  • However, early treatment of 10,000 children would prevent 330 cases of cirrhosis, 18 cases of hepatocellular carcinoma, and 48 liver-related deaths.
  • The investigators presented an additional scenario treating children as young as 3 years of age and using alternative treatment with the pan-genotypic combination of glecaprevir/pibrentasvir for 8 weeks; using glecaprevir/pibrentasvir resulted in an incremental cost effectiveness of $12 563 per QALY compared with deferring treatment to age 18 years.

All cost effective models have built in assumptions. This model, for example, presumes each patient is offered treatment only once and does not get reinfected before age 18 years.

Other aspects about early treatment that are difficult to quantitate:

  • Improved adherence at younger age which improves cost effectiveness
  • Reduction in transmission of HCV as a consequence of successful treatment
  • Detrimental effects of untreated/deferred treatment HCV on quality of life, psychosocial health, and cognitive functioning

My take: This study (& editorial) demonstrate that early treatment of HCV is a good value and delivers non-economic benefits as well. Every child (>3 years) with HCV should be treated and cured of HCV infection.

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