Page 28 - The Flying Publisher Guide to Hepatitis C Treatment

28 | Hepatitis C Treatment

improve biochemically and histologically. Therapeutic options
for these individuals include (AISF 2009):
– Retreatment with current SoC; the use of higher doses
and/or extended duration of treatment, maintenance
therapy with PegIFN – described in detail in chapter 3.
– The use of newly developed direct-acting antivirals (DAA) –
described in detail in chapter 4.
The overall objectives of new therapeutic strategies are to
prevent complications of end-stage liver disease and death from
HCV infection. In this respect, patients with compensated
cirrhosis are candidate for (re)treatment in order to prevent
decompensation. For patients with decompensated disease the
aim of treatment is to improve survival, while waiting for liver
transplant. The benefits and challenges posed by these
approaches are detailed in chapter 5.

Outlook
The management of patients with CHC is complex and
challenging, due to the potential AEs of antiviral therapies and
common co-morbidities often found in this group of patients.
Studies have shown that a multidisciplinary team-based
management approach can improve treatment outcomes in a
cost-effective manner.
Early treatment involves providing SoC therapy to all patients
with mild disease, some of whom will never progress to the
moderate to severe stage. This approach is associated with
increased costs per quality-adjusted lifeyears (QALY) gains.
Moreover, drug costs and excess costs for monitoring patients
are all incurred in the first year of the strategy, rather than at a
future date determined by the rate of disease progression
(Hartwell 2011).
In contrast, the watchful waiting strategy involves providing
antiviral treatment only to those patients with disease
progression. This is mostly based on the fact that although
antiviral therapy prevents complications and decreases the
overall severity and duration of the illness, its long-term benefit