The Cost-effectiveness, Health Benefits, and Financial Costs of New Antiviral Treatments for Hepatitis C Virus

August 29, 2015 at 7:30 pm

Clinical Infectious Diseases JUL 15, 2015 V.61 N.2 P.157-168

Editor’s Choice

David B. Rein, John S. Wittenborn, Bryce D. Smith, Danielle K. Liffmann, and John W. Ward

1Public Health Department, NORC at the University of Chicago, and

2Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia

Correspondence: David B. Rein, PhD, NORC at the University of Chicago, Public Health Department, 3520 Piedmont Rd NE, Ste 225, Atlanta, GA 30305 (rein-david@norc.org).

Background

New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications, increasing demand for treatment and healthcare costs. The cost-effectiveness of new treatments is unknown.

Methods

We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the US population aged 20 and older to estimate cases identified, treated, sustained viral response, deaths, medical costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective.

Results

Compared to treatment with pegylated interferon and ribavirin (PR), and a protease inhibitor for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555 226, reduced deaths by 80 682, and increased costs by $26.2 billion at an ICER of $47 304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1 110 451 and reduced deaths by an additional 164 540 at an incremental cost of $80.1 billion and an ICER of $72 169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24 921 and $25 405 per QALY gained as compared to PRS/SR.

Conclusions

New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing.

PDF

http://cid.oxfordjournals.org/content/61/2/157.full.pdf

Entry filed under: Antivirales no HIV, Biología Molecular, Hepatitis C, Infecciones virales, Metodos diagnosticos. Tags: .

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