Empirical evidence supporting the cost savings associated with direct-acting antivirals (DAAs) in real-world populations, and thus wider access, is limited. To investigate the impact of successful treatment of hepatitis C (HCV) with DAA therapy on healthcare services utilization (HSCU), investigators used data from a study prospectively following nearly 2,000 HIV-HCV co-infected patients. The impact of sustained virologic response (SVR) on HCSU was evaluated among those who achieved SVR after initiating DAA. The model used in the study controlled for pre-treatment trends in HCSU, exposure time, time updated covariates (CD4 cell count, HIV RNA, active injection drug use, significant fibrosis), and fixed covariates (age, sex). Among 455 participants who completed DAA therapy, 424 achieved SVR. Out-patient visits decreased from 12.6 per person-year before DAA initiation to 9.4 post-SVR, while in-patient visits decreased from 2.8 per person-year to 1.4. Prior to DAA initiations, annual rates of emergency room (ER) and specialist visits increased, hospitalization and HIV visits were stable, and general practitioner and walk-in clinic visits decreased over time. Immediately after achieving SVR, hospitalization, ER, and specialist visits reduced and continued, with annual reductions of 13%, 6%, and 18%, respectively.
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