Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;23(6):1059-1070.
doi: 10.1007/s10198-021-01409-7. Epub 2021 Dec 2.

Value appropriation in hepatitis C

Peter Lindgren  1   2 , Sofia Löfvendahl  3 , Gunnar Brådvik  3 , Ola Weiland  4 , Bengt Jönsson  5
Affiliations

Value appropriation in hepatitis C

Peter Lindgren et al. Eur J Health Econ. 2022 Aug.

Abstract

Background: In 2015, the Swedish government in an unprecedented move decided to allocate 150 million € to provide funding for new drugs for hepatitis C. This was triggered by the introduction of the first second generation of direct-acting antivirals (DAAs) promising higher cure rates and reduced side effects. The drugs were cost-effective but had a prohibitive budget impact. Subsequently, additional products have entered the market leading to reduction in prices and expansions of the eligible patient base.

Methods: We estimated the social surplus generated by the new DAAs in Stockholm, Sweden, for the years 2014-2019. The actual use and cost of the drugs was based on registry data. Effects on future health care costs, indirect costs and QALY gains were estimated using a Markov model based primarily on Swedish data and using previous generations of interferon-based therapies as the counterfactual.

Results: A considerable social surplus was generated, 15% of which was appropriated by the producers whose share fell rapidly over time as prices fell. Most of the consumer surplus was generated by QALY gains, although 10% was from reduced indirect costs. QALY gains increased less rapidly than the number of treated patients as the eligibility criteria was loosened.

Conclusions: The transfer of funds from the government to the regions helped generate substantial surplus for both consumers and producers with indirect costs playing an important role. The funding model may serve as a model for the financing of innovative treatments in the future.

Keywords: Consumer surplus; Cost-effectiveness; Hepatitis C; Pharmaceutical reimbursement; Producer surplus.

PubMed Disclaimer

Conflict of interest statement

PL, SL and GB are employed by the Swedish Institute for Health Economics, an independent research organization with work funded by different stakeholders in health care, including manufacturers of hepatitis C drugs. OW and BJ reports consultancies and speakers’ bureaus with AbbVie, BMS, Gilead and MSD/Merck.

Figures

Fig. 1
Fig. 1
State transition diagram of the hepatitis C-model. Patients who do not progress remain in their current state. Transitions to death are possible from all states. F0–F4: fibrosis stage 0 to 4, stage 4 equals cirrhosis; SVR: sustained virologic response
Fig. 2
Fig. 2
Number of treated patients by genotype and fibrosis stage
Fig. 3
Fig. 3
Relative change in the social surplus and its components compared to 2014
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Liang TJ, Ghany MG. Current and future therapies for hepatitis C virus infection. N Engl. J. Med. 2013;368(20):1907–1917. doi: 10.1056/NEJMra1213651. - DOI - PMC - PubMed
    1. Brennan T, Shrank W. New expensive treatments for hepatitis C infection. JAMA. 2014;312(6):593–594. doi: 10.1001/jama.2014.8897. - DOI - PubMed
    1. Puig-Junoy J, Pascual-Argente N, Puig-Codina L, Planellas L, Solozabal M. Cost-utility analysis of second-generation direct-acting antivirals for hepatitis C: a systematic review. Expert Rev. Gastroenterol. Hepatol. 2018;12(12):1251–1263. doi: 10.1080/17474124.2018.1540929. - DOI - PubMed
    1. Ministry of Health and Social Affairs: Statens bidrag till landstingen för kostnader för läkemedelsförmånerna m.m. för år 2015 [government transfers to the county council for costs linked to the pharmaceutical benefit}. Stockholm (2015)
    1. Emilsson L, Lindahl B, Koster M, Lambe M, Ludvigsson JF. Review of 103 Swedish healthcare quality registries. J. Intern. Med. 2015;277(1):94–136. doi: 10.1111/joim.12303. - DOI - PubMed

Substances