Background: The goal of chronic hepatitis C treatment is to remove the virus to avoid progression of HCV-related\ndisease. Sustained virologic response (SVR) is the most widely used efficacy endpoint in clinical studies of hepatitis C,\nand represents the eradication of HCV from the body. The aim of the current review was to examine the long-term\nclinical, economic and quality of life benefits associated with achieving SVR.\nMethods: A systematic literature review was performed using the PubMed, EMBASE and Cochrane library databases to\nidentify articles examining the clinical, economic and quality of life benefits associated with SVR, published in English\nlanguage from 2002ââ?¬â??2013. For inclusion studies were required to enroll ?100 patients and to report clinical endpoints\nincluding hepatocellular carcinoma, overall- or liver-related mortality, or progression of disease/complications (e.g.\nportal hypertension, esophageal varices). Review of economic studies on cost/cost-effectiveness of achieving SVR were\nfocused on studies assessing boceprevir/telaprevir plus pegIFN and ribavirin as this represents the current standard of\ncare in several jurisdictions worldwide. Quality of life evidence was required to use validated quality of life instruments\nand provide a quantitative analysis of the impact of SVR versus no treatment or treatment failure.\nResults: SVR is durable with late relapse rates over 4ââ?¬â??5 year periods being in the range of 1ââ?¬â??2%. Patients who\nachieve SVR frequently demonstrate some regression of fibrosis/cirrhosis and have a substantially reduced risk for\nhepatocellular carcinoma (relative risk [RR] 0.1ââ?¬â??0.25), liver-related mortality (RR 0.03ââ?¬â??0.2) and overall mortality\n(RR 0.1ââ?¬â??0.3) in comparison with no treatment or treatment failure. In the 5 years post-treatment, medical costs for\npatients achieving SVR are 13-fold lower than patients not achieving SVR. Patients who achieve SVR also have health\nstate utility values that are 0.05 to 0.31 higher than non-responders to treatment.\nConclusions: SVR represents the fundamental goal of antiviral treatment for patients infected with chronic HCV, so as to\nreduce risk of liver disease progression. Achievement of SVR has implications beyond those of clearing viral infection; it is\nassociated with improved long-term clinical outcomes, economic benefits and improved health-related quality of life.
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