Cost‐effectiveness and budget impact of interferon‐free direct‐acting antiviral‐based regimens for hepatitisCtreatment: theFrench case

Abstract

We evaluated the cost-effectiveness and the budget impact of new DAA-based regimen use in France. A Markov model simulated chronic hepatitis C (CHC) treatment interventions with IFN-based and IFN-free regimens at stage of fibrosis ≥F3, ≥F2 or regardless of fibrosis stage, and treatment either with the least or the most expensive combination. It estimated quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). It also assessed the budget impact over 5 years of treating all CHC-screened patients, regardless of fibrosis, assuming ≤20 000 patients treated/year and priority to ≥F3. Sensitivity analyses were also conducted. For genotypes (G) 1-4, the initiation of IFN-free regardless of fibrosis was a cost-effective strategy compared to prior standard of care (SOC) initiated at stage F2: €40 400-88 300/QALY gained in G1; similar results were obtained for patients infected with G4. Considering G2-3, the most cost-effective strategy was IFN-based regimens regardless of fibrosis compared to prior SOC initiated at stage F2: €21 300 and €19 400/QALY gained, respectively; the strategy with IFN-free regimens being more effective but not cost-effective at current costs. The budget impact of treating all CHC-screened patients over 5 years would range between 3.5 and 7.2 billion €, depending on whether one considers the least or the most expensive combination of new DAAs and whether one treats G2-3 with IFN-based or IFN-free new DAAs. In France, treatment initiation with new DDAs regardless of fibrosis stage is cost-effective, but would add 3.5-7.2 billion € to an already overburdened medical care system.

The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

“…After duplicate removal, 664 references were screened by title and abstracts. Of these, a total of 88 references underwent full text assessment and 14 individual studies of populations living in low HCV prevalence countries were included ( Table 2 ) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ].…”

“…Non-pan-genotypic DAA therapies have also been found to be moderately cost-effective, however they had a large budget impact at the 2015 cost of treatment [ 31 ]. Deuffic-Burban found that DAAs were moderately cost-effective for genotypes 1 and 4 regardless of fibrosis stage, ranging from €40,000 to €88,000 per quality-adjusted life year (QALY) gained ( Table 2 ).…”

Feasibility of reaching world health organization targets for hepatitis C and the cost‐effectiveness of alternative strategies

“…With the introduction of direct‐acting antivirals (DAAs), treatment of hepatitis C patients has been revolutionized with more than 90% being cured with considerably less side effects than the previous interferon‐based treatment. Despite their high prices, these new drugs have been shown to be cost‐effective for some or all genotypes in jurisdictions such as the UK, Canada, France, United States, Australia and Norway …”

The Egyptian hepatitis C programme: A model of HCV treatment intervention?

“…4 However following access to drugs at generic costs and fall of HCV drug prices (three-month course of HCV treatment has dropped by 85% in Egypt over the last years) treatment initiation with DAA regardless of the liver fibrosis stage is increasingly likely to be cost-effective in low and middle-income countries, as observed in high income countries. 6 Whilst the programme in Egypt is impressive, about 750,000 HCV-infected persons have been treated since 2007, estimates would suggest that only less than 10% of HCV viraemic subjects have been treated to date. More recent data from Egypt reflects the experience in other countries with rapid scale up (e.g.…”