ImportancePrevalence of chronic hepatitis C virus (HCV) infection among pregnant people is increasing in the US. HCV is transmitted vertically in 7% to 8% of births. Direct-acting antiviral (DAA) therapy was recently approved for children with HCV who are 3 years or older. The clinical and economic impacts of early DAA therapy for young children with HCV, compared with treating at older ages, are unknown.ObjectiveTo develop a state-transition model to project clinical and economic outcomes for children with perinatally acquired HCV to investigate the cost-effectiveness of treating at various ages.Design, Setting, and ParticipantsThe study team modeled the natural history of perinatally acquired HCV to simulate disease progression and costs of a simulated a cohort of 1000 US children with HCV from 3 years old through death. Added data were analyzed January 5, 2021, through July 1, 2022.InterventionsThe study compared strategies offering 8 weeks of DAA therapy at 3, 6, 12, or 18 years old, as well as a comparator of never treating HCV.Main Outcomes and MeasuresOutcomes of interest include life expectancy from 3 years and average lifetime per-person health care costs. Other clinical outcomes include cases of cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma (HCC).ResultsThe study team projected that treating HCV at 3 years old was associated with lower mean lifetime per-person health care costs ($148 162) than deferring treatment until 6 years old ($164 292), 12 years old ($171 909), or 18 years old ($195 374). Projected life expectancy was longest when treating at 3 years old (78.36 life years [LYs]) and decreased with treatment deferral until 6 years old (76.10 LYs), 12 years old (75.99 LYs), and 18 years old (75.46 LYs). In a cohort of 1000 children with perinatally acquired HCV, treating at 3 years old prevented 89 projected cases of cirrhosis, 27 cases of HCC, and 74 liver-related deaths compared with deferring treatment until 6 years old. In sensitivity analyses, increasing loss to follow-up led to even greater clinical benefits and cost savings with earlier treatment.Conclusions and RelevanceThese study results showed that DAA therapy for 3-year-old children was projected to reduce health care costs and increase survival compared with deferral until age 6 years or older. Measures to increase DAA access for young children will be important to realizing these benefits.

中文翻译：

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围产期获得性丙型肝炎病毒治疗时机策略的成本效益

重要性在美国，孕妇慢性丙型肝炎病毒 (HCV) 感染的患病率正在增加。HCV 在 7% 至 8% 的新生儿中垂直传播。直接作用抗病毒 (DAA) 疗法最近被批准用于 3 岁或以上的 HCV 儿童。与大龄儿童治疗相比，早期 DAA 治疗对幼儿 HCV 的临床和经济影响尚不清楚。 目的开发一种状态转换模型，预测围产期 HCV 儿童的临床和经济结果，以调查其成本效益设计、环境和参与者 研究小组对围产期获得 HCV 的自然病程进行了建模，以模拟 1000 名美国儿童从 3 岁到死亡期间感染 HCV 的模拟队列的疾病进展和费用。添加的数据于 2021 年 1 月 5 日至 2022 年 7 月 1 日进行分析。 干预措施 该研究比较了在 3、6、12 或 18 岁时提供 8 周 DAA 治疗的策略，以及从不治疗 HCV 的比较策略。主要结果和感兴趣的衡量结果包括 3 年预期寿命和人均终生医疗保健费用。其他临床结果包括肝硬化、失代偿性肝硬化和肝细胞癌 (HCC) 病例。结果研究小组预测，与将治疗推迟到 6 岁相比，在 3 岁时治疗 HCV 的人均终生医疗保健费用较低（148 162 美元）。岁（$164 292）、12 岁（$171 909）或 18 岁（$195 374）。3 岁时接受治疗时，预计预期寿命最长（78.36 生命年 [LYs]），并且随着治疗推迟至 6 岁（76.10 LYs）、12 岁（75.99 LYs）和 18 岁（75.46 LYs）时，预计预期寿命下降。在一个由 1000 名围产期感染 HCV 的儿童组成的队列中，与推迟到 6 岁时治疗相比，在 3 岁时接受治疗可预防 89 例预计的肝硬化病例、27 例 HCC 病例和 74 例与肝脏相关的死亡。在敏感性分析中，随访损失的增加导致早期治疗带来更大的临床效益和成本节省。结论和相关性这些研究结果表明，与 3 岁儿童相比，DAA 治疗预计将降低医疗保健成本并提高生存率推迟到 6 岁或以上。增加幼儿获得 DAA 的机会对于实现这些好处非常重要。