Impact of All‐Oral Direct‐Acting Antivirals on Clinical and Economic Outcomes in Patients With Chronic Hepatitis C in the United States

Approved treatment for hepatitis C virus (HCV) with all‐oral direct‐acting antivirals (DAA) therapy is now entering into its fourth year; however, little has been reported on the real‐world clinical (decompensated cirrhosis [DCC] and hepatocellular carcinoma [HCC]) and economic outcomes. A retrospective cohort analysis of the Truven Health MarketScan Database (2012‐2016) was conducted. In a cohort of 26,105 patients with newly diagnosed HCV, 30% received all‐oral DAA therapy (DAA group) and 70% were not treated (untreated group). Multivariate Cox proportional hazards models were used to compare the risk of developing HCC and DCC, stratified by cirrhosis status. Among patients with cirrhosis (n = 2157), DAA therapy was associated with a 72% and a 62% lower incidence of HCC (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.15‐0.52) and DCC (HR, 0.38; 95% CI, 0.26‐0.56). Similarly, DAA therapy was associated with a 57% and a 58% lower incidence of HCC (HR, 0.43; 95% CI, 0.26‐0.71) and DCC (HR, 0.42; 95% CI, 0.30‐0.58) in patients with noncirrhotic HCV (n = 23,948). A propensity score–matched cohort of 8064 HCV‐infected patients who had at least a 12‐month follow‐up after HCV treatment was included for economic analysis. For patients with cirrhosis in the DAA group, the mean adjusted liver‐related costs ($1749 vs. $4575; P < 0.001) and all‐cause medical costs ($19,300 vs. $33,039; P < 0.001) were significantly lower compared with those in the untreated group. The mean adjusted costs were not statistically different between the two groups among patients without cirrhosis. Conclusion: In the short term, all‐oral DAA treatment for HCV infection was associated with a decreased risk of developing HCC and DCC, resulting in decreased health care costs, especially in patients with cirrhosis. A longitudinal study is necessary to confirm our findings.