Su1035 Treating Chronic Hepatitis C Infection in the Elderly: Estimated Impact on Life Expectancy

Hepatitis C virus (HCV) infection continues to be a significant contributor to morbidity and mortality in the United States and throughout the world. Due to latency of infection, HCV is expected to cause an increasing number of liver-related deaths over the next 10 years despite a dramatic drop in incidence over the last 20 years. The present recommended treatment for patients with chronic HCV infection is triple therapy with pegylated interferon α, ribavirin and a protease inhibitor (PI). There are no guidelines for treatment in the elderly (defined as 65 years and older). As the largest cohort with HCV ages, it has become critical to evaluate the effect of treatment on life expectancy in elderly patients. We used a simple decision analysis model to simulate the impact of HCV treatment on life expectancy. Cohorts separated by gender entered the model at five age groups (60 to 80) and at the five stages of liver fibrosis (F0 to F4). The primary outcome was mean life expectancy and number of life years gained. Hazard ratios for all-cause mortality in cirrhosis before and after achieving sustained virologic response (SVR) were applied to baseline annual mortality rates to obtain F4-specific mortality rates. Sensitivity analysis was performed to ensure results were robust over a wide range of values. Our model demonstrated that the greatest life expectancy benefit of treatment was derived from treatment of younger patients with higher levels of fibrosis. Overall, men benefitted more than woman, with equalization of this benefit in cirrhosis. In our base-case scenario with a SVR rate of 70%, the mean years of life expectancy gained across all ages and stages of fibrosis were 2.18 years for women and 2.95 years for men. Based on a treatment threshold of 6 months of life expectancy gained, only men between 60 and 70 should be treated in the F0 cohort. From F2 and above, all cohorts reached our threshold value. The rate of SVR affected number of life years gained but did not substantially alter treatment decisions. Elderly patients have higher rates of progression of liver fibrosis and are more likely to present with complications of liver disease. Although prior studies on treatment of patients older on 65 are limited, data exists that these patients respond with similar rates of SVR as younger patients. Furthermore, recent studies have shown a clear decrease in liver-related morbidity and mortality if SVR is achieved. Given our findings of improved survival, this study highlights the importance of treatment in this at-risk cohort especially as shorter regimens and higher SVR rates are anticipated with upcoming PIs. Our results provide evidence for consideration of HCV treatment in clinical practice for all men between 60and 70-years of age and any patient of either gender with advanced fibrosis or cirrhosis. Life expectancy gains and treatment recommendations stratified by age, gender and fibrosis