Treatment of acute hepatitis C virus is cost‐effective but at what price?
Notice bibliographique
Résumé
Potential conflict of interest: Nothing to report. TO THE EDITOR: Bethea et al.1 provide an interesting study modeling that early treatment of acute hepatitis C virus (HCV) is cost‐effective and potentially cost‐saving in a group at high risk of transmission rather than waiting until chronicity is confirmed in 6 months' time. Current American Association for the Study of Liver Diseases guidelines2 recommend against treating acute HCV given a spontaneous clearance rate of approximately 28%.3 Acute HCV is largely asymptomatic, so identified cases will typically have symptoms, particularly jaundice; spontaneous clearance may approach 50% in patients with jaundice.4 Initial data suggest that shorter treatment courses are efficacious for acute HCV, although the trials are small and only genotype 1 was studied. The reduced length of treatment is the key determinant of the differences between the strategies cost‐wise in this model; as more patients spontaneously clear, the cost‐effectiveness of treating acute HCV decreases. Although this study suggests that early treatment is cost‐effective in patients at low risk of transmission and cost‐saving for patients at high risk of transmission, implementing an acute treatment strategy carries the risk of significant unnecessary costs for patients who would otherwise spontaneously clear the infection. Assuming a spontaneous clearance rate of 28% and 34,000 acute HCV infections in the United States annually, 9,520 people would receive potentially unneeded therapy. As such, between $4,598,160 and $79,225,440 (2016 USD) of unnecessary spending would be required depending on whether acute HCV required 6 or 8 weeks of treatment versus 8 weeks for chronic HCV. For patients at high risk of transmission, if both strategies require an 8‐week treatment duration, there could be an additional cost of $27,398,560, while if acute HCV could be treated with a shorter duration, early treatment would be cost‐saving due to the reduced risk of transmission. The authors provide important data for policy makers and clinicians to consider; however, we would caution against any major changes for patients at low risk of transmission until further data on the efficacy of direct‐acting antiviral agents are available for all genotypes given the significant expense for patients who would spontaneously clear. For patients at high risk of transmission, the added cost of treating individuals who would otherwise spontaneously clear may be of value given reduced transmission rates if acute HCV requires similar treatment duration to chronic HCV. If a shorter duration is possible, early treatment of high‐risk patients with acute HCV would be good public health policy given that it is cost‐saving.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».