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. 2015 Jul 15;61(2):157-68.
doi: 10.1093/cid/civ220. Epub 2015 Mar 16.

The cost-effectiveness, health benefits, and financial costs of new antiviral treatments for hepatitis C virus

David B Rein  1 , John S Wittenborn  1 , Bryce D Smith  2 , Danielle K Liffmann  1 , John W Ward  2
Affiliations

The cost-effectiveness, health benefits, and financial costs of new antiviral treatments for hepatitis C virus

David B Rein et al. Clin Infect Dis. .

Abstract

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.

Keywords: antiviral treatment; cost-effectivenes; hepatitis C; pharmacoeconomics; public health.

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Conflict of interest statement

Potential conflicts of interest. All authors: No potential conflicts of interest.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1
Figure 1
Estimated incremental change in per person costs and per person quality-adjusted life-years estimated across 9 published scenarios that tested population hepatitis C virus testing followed by treatment. Abbreviations: PR, pegylated interferon and ribavirin; QALY, quality-adjusted life-year.
Figure 2
Figure 2
Incremental cost-effectiveness by liver fibrosis score as measured by METAVIR score. Abbreviations: ICER, incremental cost-effectiveness ratio; PRS/SR, pegylated interferon, ribavirin and sofosbuvir for genotypes 1 and 4, and sofosbuvir and ribavirin for genotypes 2 and 3; SS/SR, sofosbuvir and simeprevir for genotypes 1 and 4, and sofosbuvir and ribavirin for genotypes 2 and 3.
Figure 3
Figure 3
A, Univariate sensitivity to changes in key model parameters of pegylated interferon, ribavirin, and sofosbuvir treatment for G1 and sofosbuvir/ribavirin treatment for G2 and 3 compared to pegylated interferon, ribavirin, and protease inhibitor treatment for G1 and pegylated interferon and ribavirin for G2 and 3. B, Univariate sensitivity to changes in key model parameters of sofosbuvir and simeprevir treatment for G1 and sofosbuvir/ribavirin treatment for G2 and 3 compared to pegylated interferon, ribavirin, and sofosbuvir treatment for G1 and sofosbuvir/ribavirin treatment for G2 and 3. Univariate sensitivity analysis included all parameters from Tables 1 and 2. Tested ranges based on the upper and lower 95% confidence interval bound for each parameter. Only parameters with a >5% impact on ICER are shown. Assumes birth cohort testing is implemented. Abbreviations: DCC, decompensated cirrhosis; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; SVR, sustained viral response.
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References

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