Effectiveness and cost of hepatitis C virus cryoglobulinemia vasculitis treatment: from interferon-based to direct acting antivirals era

Background: The net benefits of new hepatitis C virus (HCV) direct acting antiviral drugs (DAA) in patients with cryoglobulinemia vasculitis (CryoVas) are unknown. Objective: To analyze the effectiveness and cost of all treatments used for HCV-CryoVas in the DAA versus pre-DAA era. Methods: A chart review of all HCV-CryoVas patients who received antivirals from 1993 to 2016 in a tertiary center was performed. Treatment effectiveness was analyzed for clinical, immunological and virological responses. Cost analyses included anti-HCV treatments, non-antiviral drugs, plasmapheresis, dialysis, and hospitalizations. We compared main data in the pre-DAA versus DAA period. Results: 201 HCV-CryoVas patients were included (women, 53.2%; mean age, 59.2 years; Metavir score F3-F4, 36.7%; genotype 1, 64.2%). Patients in the DAA era (n=27) compared to those in the pre-DAA era (n=174) showed higher rates of clinical (96.3% vs. 78.6%), immunological (89.5% vs. 77.1%), and sustained virological response (75.0% vs. 42.8%). Death rate was 14.8% vs. 24.4%, respectively. In the DAA compared to pre-DAA era, mean cost of anti-HCV drugs increased from 11,855 to 57,632 € while mean CryoVas-related cost decreased for both hospitalizations (from 33,510 to 21,347€) and non-antiviral treatments (from 17,347 to 11,397€). Conclusion: Improved antiviral efficacy of HCV drugs in the DAA era led to increased clinical and immunological efficacy and a lower death rate. Use of DAAs was associated to higher costs for HCV drugs while costs related to both hospitalizations and non-antiviral treatments decreased.