Background: While the primary endpoint for patients transplanted for Hepatitis C (HCV) has been established as sustained virologic response (SVR), different pathways have existed to achieve this, with only one recently approved but costly therapy. This study examines clinical and economic outcomes of previous interferon (IFN) based therapies in contrast to the current direct-acting antivirals (DAA).

Methods: Between January 2000 and May 2014, 413 patients received an OLT due to HCV infection at a single center. 143 patients received IFN and 63 patients received DAA per manufacturer recommended dosing for HCV management. Multiple clinical histology and cost data were collected before and after therapy. Primary endpoint was histology before and after treatment and secondary endpoints included comparisons between IFN and DAA for clinical, histologic, and charge comparisons for the HCV treatment.

Results: Of the patients analyzed, 143 received IFN and 63 received DAA. Patients who had DAA therapy were more likely to achieve an SVR (p=0.007, N=206). 59 (94%) achieved SVR on DAA therapy compared to 52 (36%) on IFN. Applying these rates to a standard 50 SVRs shows that 139 IFN patients would need treatment to achieve 50 SVRs, compared to 54 DAA patients to achieve 50 SVRs. Grade of inflammation 0-2 years post-treatment was significant for patients who achieved an SVR compared to those who did not (p=0.007, N=206), regardless of treatment. Within those with SVR, type of treatment was associated with the change in fibrosis from pre- to post-treatment (p=0.013, N=105), with DAA patients more likely to see a decrease in fibrosis. Cirrhosis was seen in 10 IFN patients and 3 DAA patients 0-2 years post-treatment. Average charges (not corrected for discounts or contracts) were $26109 for IFN + ribavirin and $211000 for DAA (including ribavirin when indicated.

Conclusions/Implications: With the advent of DAA therapies, it is important to understand overall implications, in particular the histologic differences in patients treated with DAA vs. IFN. Patients receiving DAA therapy have better histological outcomes with less fibrosis. Although IFN may be less expensive, it comes with complications that contribute to its decreased success to SVR. Any reduction in cost from using IFN over DAA therapy is offset by treatment costs associated with worsening fibrosis or adverse effects related to IFN therapy.

CITATION INFORMATION: Olson S, McCann A, Kumer S, Schmitt T, Floyd B, Taylor R, Gilroy R. Clinical, Histologic and Charge Endpoints When Populations with Hepatitis C Recurrence Are Treated with Direct-Acting Antiviral or Interferon Based Therapies. Am J Transplant. 2016;16 (suppl 3).

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