Long‐Term Effects of Direct‐Acting Antivirals on Hepatitis C: Trends in Liver Disease–Related Hospitalisations in Italy

This study aimed to evaluate the effectiveness of direct-acting antivirals (DAAs) on hepatitis C virus (HCV) hospitalisation trends in Italy, the country with not only the highest burden of HCV-related disease but also the highest number of patients treated for chronic HCV infection in Europe. Incident hospital discharge records in Italy from 2012 to 2019 that included a liver cirrhosis diagnosis without mention of alcohol, hepatocellular carcinoma (HCC), HCV and liver cirrhosis without mention of alcohol and/or HCC, cirrhosis with mention of alcohol, as defined by the International Classification of Diseases (ICD-9-CM) were reviewed. An interrupted time series analysis compared the incidence of cirrhosis and HCC before and after the introduction of DAAs (Year 2015). Overall, non-alcoholic cirrhosis significantly decreased after the introduction of DAAs (β₃ = 0.03) and for those 40-59 years of age (β₃ = 0.025). HCV with cirrhosis and/or HCC significantly reduced overall for those aged 40-59 and older than 60 ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics> <mml:mrow><mml:msub><mml:mi>β</mml:mi> <mml:mn>3</mml:mn></mml:msub> <mml:mo>=</mml:mo> <mml:mn>0.002</mml:mn></mml:mrow> <mml:annotation>$$ {\beta}_3=0.002 $$</mml:annotation></mml:semantics> </mml:math> ). HCC-related hospitalisation rates significantly decreased in patients younger than 60 ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics> <mml:mrow><mml:msub><mml:mi>β</mml:mi> <mml:mn>3</mml:mn></mml:msub> <mml:mo>=</mml:mo> <mml:mn>0.03</mml:mn></mml:mrow> <mml:annotation>$$ {\beta}_3=0.03 $$</mml:annotation></mml:semantics> </mml:math> ). Cirrhosis-related hospitalisations with mention of alcohol did not differ during the study period before and after the year 2015 ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics> <mml:mrow><mml:msub><mml:mi>β</mml:mi> <mml:mn>3</mml:mn></mml:msub> <mml:mo>=</mml:mo> <mml:mn>0.4</mml:mn></mml:mrow> <mml:annotation>$$ {\beta}_3=0.4 $$</mml:annotation></mml:semantics> </mml:math> ). There was a significant reduction in HCV-related hospitalisations throughout Italy after introducing DAAs.