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Estimates of comparative efficacy promote competition between pharmaceutical companies but direct acting antivirals have been approved for the treatment of HCV without comparative trials. We emulated a randomized trial to answer the question of whether easy to treat patients with genotype 1 HCV could be treated with sofosbuvir\/ledipasvir (SOF\/LDV) rather than sofosbuvir\/velpatasvir (SOF\/VEL). Patients without comorbidities or end stage liver disease were selected from the British Colombia Hepatitis Testers Cohort. To create a conceptual trial, we matched each patient starting SOF\/VEL (a \u2018case\u2019) to the patient starting SOF\/LDV with the closest propensity score (a \u2018control\u2019). We estimated the probability of treatment failure under a Bayesian logistic model with a random effect for each case\u2010control set and used that model to give an estimate of a risk difference for the conceptual trial. Treatment failure was recorded for 27 of 825 (3%) cases and for 29 of 602 (5%) matched controls. Estimates from our model were treatment success rates of 97% (95% credible interval, CrI, 95%\u201098%) for treatment with SOF\/VEL, 95% (95% CrI 93%\u201097%) for treatment with SOF\/LDV and a risk difference between treatments of 2% (95% CrI 0%\u20104%). This risk difference is evidence that SOF\/LDV is not inferior to SOF\/VEL for easy to treat patients with genotype 1 HCV. The approach is a template for comparing drugs when there are no data from comparative trials.<\/jats:p>","DOI":"10.1002\/prp2.650","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T16:55:49Z","timestamp":1601312149000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Comparing direct acting antivirals for hepatitis C using observational data \u2013 Why and how?"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4314-3007","authenticated-orcid":false,"given":"Jim","family":"Young","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Chronic Viral Illness Service Department of Medicine Glen Site McGill University Health Centre Montreal QC Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health Faculty of Medicine McGill University Montreal QC Canada"},{"name":"Basel Institute for Clinical Epidemiology and Biostatistics University Hospital Basel University of Basel Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stanley","family":"Wong","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Disease Control Vancouver BC Canada"},{"name":"School of Population and Public Health University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naveed Z.","family":"Janjua","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Disease Control Vancouver BC Canada"},{"name":"School of Population and Public Health University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3063-8430","authenticated-orcid":false,"given":"Marina B.","family":"Klein","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Chronic Viral Illness Service Department of Medicine Glen Site McGill University Health Centre Montreal QC Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health Faculty of Medicine McGill University Montreal QC Canada"},{"name":"CIHR Canadian HIV Trials Network Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,9,7]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"US Food and Drug Administration.Chronic hepatitis C virus infection: developing direct\u2010acting antiviral drugs for treatment \u2010 guidance for industry. US Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research. https:\/\/www.fda.gov\/regulatory\u2010information\/search\u2010fda\u2010guidance\u2010documents\/chronic\u2010hepatitis\u2010c\u2010virus\u2010infection\u2010developing\u2010direct\u2010acting\u2010antiviral\u2010drugs\u2010treatment\u2010guidance (last updated Nov 2017 accessed 23 Sep 2019)."},{"key":"e_1_2_10_3_1","first-page":"54","article-title":"Once\u2010a\u2010day Harvoni (ledipasvir plus sofosbuvir), a new oral combination for the treament of patients with genotype 1 chronic hepatitis C infection","volume":"8","author":"Raedler LA","year":"2015","journal-title":"Am Health Drug Benefits"},{"key":"e_1_2_10_4_1","first-page":"321","article-title":"Sofosbuvir\/velpatasvir for the treatment of hepatitis C virus infection","volume":"89","author":"Zignego AL","year":"2018","journal-title":"Acta Biomed"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrd3079"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(18)30354-6"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30272-4"},{"key":"e_1_2_10_8_1","unstructured":"EllisP BakerC HangerM.Research on the comparative effectiveness of medical treatments: issues and options for an expanded federal role. 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