Cost‐effectiveness of hepatitis C treatment for patients in early stages of liver disease

Abstract

New treatments for hepatitis C virus (HCV) may be highly effective but are associated with substantial costs that may compel clinicians and patients to consider delaying treatment. This study investigated the cost-effectiveness of these treatments with a focus on patients in early stages of liver disease. We developed a state-transition (or Markov) model to calculate costs incurred and quality-adjusted life-years (QALYs) gained following HCV treatment, and we computed incremental cost-effectiveness ratios (cost per QALY gained, in 2012 US dollars) for treatment at different stages of liver disease versus delaying treatment until the subsequent liver disease stage. Our analysis did not include the potential treatment benefits associated with reduced non–liver-related mortality or preventing HCV transmission. All parameter values, particularly treatment cost, were varied in sensitivity analyses. The base case scenario represented a 55-year-old patient with genotype 1 HCV infection with a treatment cost of $100,000 and treatment effectiveness of 90%. In this scenario, for a 55-year-old patient with moderate liver fibrosis (Metavir stage F2), the cost-effectiveness of immediately initiating treatment at F2 (versus delaying treatment until F3) was $37,300/QALY. For patients immediately treated at F0 (versus delaying treatment until F1), the threshold of treatment costs that yielded $50,000/QALY and $100,000/QALY cost-effectiveness ratios were $22,200 and $42,400, respectively. Conclusion Immediate treatment of HCV-infected patients with moderate and advanced fibrosis appears to be cost-effective, and immediate treatment of patients with minimal or no fibrosis can be cost-effective as well, particularly when lower treatment costs are assumed.

Potential epidemiologic, economic, and budgetary impacts of current rates of hepatitis C treatment in medicare and non‐medicare populations

“…At an ICER of $31,718 per QALY gained, we find cost‐effectiveness is similar to earlier analyses 3, 4, 5. Although these studies focused on the cost‐effectiveness of population testing, the ICER of testing interventions that include treatment is similar to treatment alone because testing costs are negligible compared to treatment costs.…”

“…Assuming a $50 testing cost and a 1% true‐positive rate, our model shows that the ICER would increase by only $2,754 to $34,472. Comparatively, Rein et al3 found sofosbuvir and ribavirin therapy achieved an ICER of $47,304 per QALY gained; Leidner et al5 found an ICER of $37,000 per QALY; while McEwan et al4 identified an ICER of $28,602. These earlier studies did not report budgetary impact forecasts.…”

“…Among chronic infection, patients are allocated to four levels of fibrosis progression (F0, F1, F2, and F3). Initial HCV stages are assigned to patients based on the baseline distribution as reported in the Chronic Hepatitis Cohort Study (CHeCs) 5. For patients enrolled in Medicare at model initiation, cirrhosis and ESLD stages are assigned based on stage allocations by age group as calculated in the 2009 data from the Surveillance, Epidemiology, and End Results (SEER) program's SEER‐Medicare data and linked Medicare 5% data.…”

“…Barriers to care as a result of the high cost of treatment have generated tremendous controversy in the areas of public discourse and have led some groups to advocate for drastic measures to expand purchasing or curtail pricing of DAA therapies 2. However, despite these high costs, multiple studies have demonstrated favorable cost‐effectiveness of these treatments 3, 4, 5. As prices continue to decrease, HCV treatment will become more cost‐effective.…”

A hepatitis C-vírus-fertőzés és kezelésének költségvonzata

“…A különbö-ző kezelési formák esetében az ismert európai átlagárak mellett a peg-IFN+RBV kezelés (a stopszabályokat betartva) a legköltséghatékonyabb naïve betegek esetében, míg a proteázgátlók vonatkozásában a boceprevirrel vég-zett, korai vírusválasz (RVR) alapján irányított kezelés a legköltséghatékonyabb [16]. Az interferonmentes kezelések részben a magas gyógyulási arány, részben a mellékhatások elenyésző volta miatt bizonyulnak költségha-tékonynak magas áruk ellenére még a betegség enyhébb fokozatának esetében is [31].…”