Treatment of acute hepatitis C virus is cost‐effective but at what price?
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".