There’s great news in the treatment of hepatitis C
, as several new
drugs have been approved by the Food and Drug Administration
and even more are in the pipeline. But the news can also be
confusing for patients and their physicians because the huge demand for these
drugs has created waiting lists for them.
More than 3.2 million people in the U.S. have Hepatitis C, and many have
never been treated for it or may not even know they have it. The waiting lists
are expected to expand further as the next generation of drugs, known as
directly acting antivirals (DAAs), are approved, leading doctors and
researchers to determine the best method of prioritizing patients for these new
Their algorithm uses a patient’s current health state, progression of
hepatitis C disease, sustained virologic response rates, patient demographics
and polymorphism near gene IL28B (which predicts treatment response). Using
data pulled from the registration trials of the first two DAAs (telaprevir and
boceprevir) and the estimated rates of hepatitis C disease progress from
several prior studies, their model projected how many years of good health
could be gained by early access to treatment. In addition, the researchers also
projected the number of decompensated cirrhosis, hepatocellular carcinoma,
liver transplant and liver-related deaths that can be prevented per 1,000
They found that younger patients with advanced liver disease suffering
from hepatitis C would benefit the most by early access to treatment with DAAs.
When all other factors were equal, the projected gain in quality-adjusted life
years due to immediate treatment as opposed to a one-year deferment was higher
in younger patients. In addition to age, prior treatment history also played an
important role in cirrhotic patients. With all other factors equal, treatment priority
should be in the following order: people who have had a prior relapse, those
who have had no prior treatment and those who previously partially responded.
Finally, they found that age did not play any role in prioritization of
patients in early stages of disease.
As drug development changes the way we treat patients with Hepatitis C,
mathematical models like this are going to become increasingly more important as
the medical community strives to maximize the value of new treatments.