DAAs reduce HCC, decompensation risk compared with no treatment

SAN FRANCISCO — Individuals with hepatitis C who underwent DAA therapy experienced significant reductions in both hepatocellular carcinoma and decompensation risk compared with untreated patients, according to data presented at The Liver Meeting 2018.

Haesuk Park, MD, assistant professor in the College of Pharmacy at the University of Florida, aimed to determine the impact of all-oral DAA treatment on the incidence rate of HCC and decompensated cirrhosis, along with the economic outcomes of DAA treatment. “We looked at liver-related costs, and all-cause costs,” Park said.

She noted that access to HCV therapy has been frequently restricted due to high drug costs, among other reasons, leading to treatment delays. “This delay may have costly consequences,” she said.

The cohort for clinical outcomes included 26,105 patients. Of that group, 7,928 received DAA’s and 18,177 were untreated. For the economic outcomes, there were 8,064 patients, with 4,032 patients each in the treated and untreated groups.

Treatment outcomes showed that DAA therapy yielded a significant reduction in risk for developing HCC compared with no treatment (HR = 0.28; 95% CI, 0.15-0.52) among patients with compensated cirrhosis. This trend persisted among those without cirrhosis, with DAA therapy also reducing HCC risk compared with no treatment (HR = 0.43; 95% CI, 0.26-0.71). “The crude incidence for HCC risk was four times higher in the untreated patients compared with treated patients,” Park said.

Sensitivity and subgroup analyses shows that this trend of reduced HCC risk for treatment vs. no treatment persisted, regardless of cirrhosis status, among patients with no cancer history; among those diagnosed with HCC 3 or more months after baseline; and among those who received minimum effective treatment. “The results were consistent,” Park said.

She added that factors associated with HCC included male sex, older age, diabetes, cirrhosis, and cancer history.

Among participants with compensated cirrhosis, DAA treatment reduced decompensation risk compared with no treatment (HR = 0.38; 95% CI, 0.26-0.56). Similarly, treatment also decreased decompensation risk among those without cirrhosis (HR = 0.42; 95% CI, 0.3-0.58). “We found that DAA therapy was associated with a 62% decrease in [decompensated cirrhosis] risk in patients with compensated cirrhosis and a 58% decrease in patients without cirrhosis,” Park said.

Cost analysis findings showed that compared with no treatment, DAA treatment reduced liver-related costs among patients with compensated cirrhosis by $2,826 (P <. 001). For all-cause costs, this reduction was $13,739 (P < .001).

“In the short term, all-oral DAA treatment for HCV infection was associated with a decreased risk of developing HCC and [decompensated cirrhosis],” Park said. “DAA treatment was associated with a decline in health expenditures for both liver-related and all-cause related costs in patients with compensated cirrhosis.”

Park noted that a longitudinal study is necessary to confirm these findings. “Despite these positive findings, and the availability of these highly effective, all-oral DAA therapies, the majority of HCV patients within our study were not treated,” Park said. – by Rob Volansky

Reference:

Park H, et al. Abstract 146. Presented at: The Liver Meeting 2018; Nov. 9-13, 2018; San Francisco.

Disclosure: Park reports no relevant financial disclosures.