Cost-Effectiveness Analysis of Sofosbuvir Compared to Current Standard Treatment in Swiss Patients with Chronic Hepatitis C

Abstract

In clinical trials, sofosbuvir showed high antiviral activity in patients infected with hepatitis C virus (HCV) across all genotypes. We aimed to determine the cost-effectiveness of sofosbuvir-based treatment compared to current standard treatment in mono-infected patients with chronic hepatitis C (CHC) genotypes 1–4 in Switzerland. Cost-effectiveness was modelled from the perspective of the Swiss health care system using a lifetime Markov model. Incremental cost-effectiveness ratios (ICERs) used an endpoint of cost per quality-adjusted life year (QALY) gained. Treatment characteristics, quality of life, and transition probabilities were obtained from published literature. Country-specific model inputs such as patient characteristics, mortality and costs were obtained from Swiss sources. We performed extensive sensitivity analyses. Costs and effects were discounted at 3% (range: 0–5%) per year. Sofosbuvir-containing treatment in mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1–4 showed ICERs between CHF 10,337 and CHF 91,570 per QALY gained. In subgroup analyses, sofosbuvir dominated telaprevir- and boceprevir-containing treatment in treatment-naïve genotype 1 cirrhotic patients. ICERs of sofosbuvir were above CHF 100,000 per QALY in treatment-naïve, interferon eligible, non-cirrhotic patients infected with genotypes 2 or 3. In deterministic and probabilistic sensitivity analyses, results were generally robust. From a Swiss health care system perspective, treatment of mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1–4 with sofosbuvir-containing treatment versus standard treatment would be cost-effective if a threshold of CHF 100,000 per QALY was assumed.

Health Economic Evaluations of Sofosbuvir for Treatment of Chronic Hepatitis C: a Systematic Review

“…1. Fourteen studies were then included in the review, all of them published in English [16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

“…In the 14 studies, which were published between 2013 and 2015, health economic evaluations for seven different countries were conducted: France [21], Germany [19], Italy [17,25], Spain [28], Switzerland [26], the UK [18] and the USA [16, 20, 22-24, 27, 29]. In all studies, the cost-effectiveness of sofosbuvir-based treatment was assessed from the perspective of the respective payer, though Zhang et al [29] did not state the perspective of their analysis.…”

“…Of those, four studies restricted their analyses to patients with genotype 1 [19,23,25,27], whereas the remaining nine studies included further genotypes. In addition, there were differences in modelling approaches (mostly Markov models), cycle lengths, currencies and WTP thresholds (€25,000 per life-year gained in Italy [17], up to US$100,000 per quality-adjusted life-year [QALY] in the USA [16,20,22,23] and CHF 100,000 in Switzerland [26]). Referring to the study results, almost all evaluations (except for those by Hagan et al [20] and Leleu et al [21]) determined ICERs/ICURs separately per genotype.…”

“…Referring to the study results, almost all evaluations (except for those by Hagan et al [20] and Leleu et al [21]) determined ICERs/ICURs separately per genotype. In several studies, additional separate analyses were performed for treatment history (n = 7) [16-18, 22, 26-28], cirrhosis status (n = 6) [16,17,22,25,27,29] and interferon eligibility (n = 3) [17,18,26].…”

“…All studies provided details of the cost parameters and calculations that were included in the analysis, though the level of detail of the presentation differed extremely. The most detailed cost data were presented by Cure et al [18], Linas et al [22] and Pfeil et al [26]. In all studies, only direct medical costs were taken into account.…”