Author information
1 Hennepin Healthcare Systems, Minneapolis, Minnesota.
2 Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
3 Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota.
4 Scientific Studies & Projects Group, Symphony Health, Conshohocken, Pennsylvania.
5 Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
6 Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
7 Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
Abstract
BACKGROUND:
Sofosbuvir use in patients with decompensated cirrhosis may be associated with reduced liver transplant waitlist mortality and reduced need for transplant.
METHODS:
Data from the Scientific Registry of Transplant Recipients were linked with a national database of pharmacy claims. All adult patients on the liver transplant waiting list on January 1, 2014, or added to the list during 2014, with hepatitis C virus as reason for listing were identified (total n = 2009). A subgroup of 1093 unique patients had consistent pharmacy claim capture and observations. We compared patients who were and were not treated with all sofosbuvir-based regimens.
RESULTS:
During the study period, 154 patients received sofosbuvir-based regimens. These patients had lower model for end-stage liver disease scores and significantly longer waiting times. We found a trend toward significance for more sofosbuvir-treated than untreated patients being removed from the waiting list due to improved condition (4.54% vs. 3.19%, P = 0.03). In a propensity-score-adjusted analysis, sofosbuvir-treated patients were less likely to undergo transplant (HR 0.57; 95% CI 0.37-0.89; P = 0.01).
CONCLUSION:
During the study period reflecting early sofosbuvir use, few liver transplant candidates received sofosbuvir. Use was associated with lower incidence of transplant and a trend toward more waitlist removals due to improved condition.