HCV Treatment Before vs. After Liver Transplantation: A Cost-Effectiveness Analysis

The direct-acting antiviral agents (DAAs) currently used for the treatment of chronic hepatitis C virus (HCV) infection are effective in patients with advanced cirrhosis as well as post–liver transplantation (LT). However, whether DAA therapy should be administered pre-LT or post-LT in patients awaiting transplantation is unclear.

Using a validated mathematical model, researchers simulated a virtual trial comparing long-term outcomes pre-LT versus post-LT. Input data were sustained virologic response rates from previous trials of sofosbuvir and ledipasvir plus ribavirin in the pre-LT and post-LT settings.

For patients with a Model for End-Stage Liver Disease (MELD) score ≤27, the quality-adjusted life year (QALY) was higher with pre-LT HCV tr…