Treatment of Chronic Hepatitis C in Young Children Reduces Adverse Outcomes: Study
Recent research published in the Journal of Pediatrics has highlighted that delaying treatment until age 18 years results in an increased lifetime risk of late-stage liver complications and that early treatment in children is considered cost effective.
In children and adolescents as in adults, HCV infection is suspected to be grossly underestimated. HCV infection across the pediatric age spectrum differs from infection acquired later in life in a variety of ways, including modes of transmission, rates of spontaneous clearance or progression of fibrosis, the potential duration of chronic infection when acquired at birth, and significantly, available treatment options.
Emma Greenaway and colleagues from the Division of Gastroenterology Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada conducted the present study with the objective to evaluate the cost-effectiveness of treating young children with chronic hepatitis C virus (HCV) with new direct-acting antivirals.
The authors developed a state-transition model of chronic HCV to conduct a cost-effective analysis comparing treatment at age 6years vs delaying treatment until age 18years.
Medical care costs were obtained from linked population level laboratory and administrative data (Ontario, Canada). Outcomes were expressed in expected quality-adjusted life-years and costs (CAD$). Analysis included a base-case to estimate the expected value and one-way and probabilistic sensitivity analyses to evaluate the impact of uncertainty of the model inputs.
The following key findings were observed-
a. After 20 years, treating 10 000 children early would prevent 330 cases of cirrhosis, 18 cases of hepatocellular carcinoma, and 48 liver-related deaths.
b. The incremental cost-effectiveness ratio of early treatment compared to delayed treatment was approximately $12 690/quality-adjusted life-years gained and considered cost-effective.
c. Model results were robust to variation in fibrosis progression rates, disease state-based costs, treatment costs, and utilities.
Therefore, the authors concluded that "Delaying treatment until age 18 years results in an increased lifetime risk of late-stage liver complications. Early treatment in children is cost effective. Our work supports clinical and health policies that broaden HCV treatment access to young children."