{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T23:13:19Z","timestamp":1779923599379,"version":"3.53.1"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"Importance<\/jats:title>Prevalence 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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To 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.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>The 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.<\/jats:p><\/jats:sec>Interventions<\/jats:title>The 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.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Outcomes 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).<\/jats:p><\/jats:sec>Results<\/jats:title>The study team projected that treating HCV at 3 years old was associated with lower mean lifetime per-person health care costs ($148\u202f162) than deferring treatment until 6 years old ($164\u202f292), 12 years old ($171\u202f909), or 18 years old ($195\u202f374). 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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>These 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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.0114","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T15:02:39Z","timestamp":1710169359000},"page":"489","source":"Crossref","is-referenced-by-count":9,"title":["Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus"],"prefix":"10.1001","volume":"178","author":[{"given":"Megan Rose","family":"Curtis","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston"},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Division of Infectious Diseases, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Boston Medical Center, 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