Cost-effectiveness of new antiviral treatments for non-genotype 1 hepatitis C virus infection in China: a societal perspective

Abstract

ObjectiveThis study aimed to estimate the cost-effectiveness of direct-acting antivirals (DAAs) among patients with non-genotype 1 for the eradication of hepatitis C virus (HCV) infection in China.MethodsA decision-analytic Markov model was developed to estimate the lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for DAAs and pegylated interferon plus ribavirin (PEG-RBV) from a societal perspective. The model inputs were derived from the literature, a patient survey, HCV expert opinions and a specialised drug price database available in China. Sensitivity analysis was conducted to evaluate the model robustness and calculate reasonable prices of DAAs.ResultsFor patients infected with HCV genotype 2, the pan-genotypic regimen sofosbuvir/velpatasvir (SOF/VEL) was the most cost-effective strategy compared with PEG-RBV, with an ICER of US$5653/QALY. For genotype 3, the combination of sofosbuvir plus daclatasvir (SOF-DCV) was the most cost-effective approach, with an ICER of US$3314/QALY. All DAA regimens for genotype 6 were cost-saving, and sofosbuvir plus ribavirin (SOF-RBV) was the optimal regimen. One-way sensitivity analysis demonstrated that the ICERs were most sensitive to the utility values, discount rate and drug costs. Probabilistic sensitivity analysis indicated that using a threshold equal to one time the gross domestic product (GDP) per capita in China (US$9769/QALY, 2018), the probability of SOF/VEL, SOF-DCV and SOF-RBV being cost-effective was 58%, 83% and 71% for genotype 2, 3 and 6, respectively. Threshold analysis showed that the price of DAAs should be reduced by some degree to achieve better affordability.ConclusionsDAAs were cost-effective compared with traditional treatments. A reasonable reduction in the price of DAAs will increase drug affordability and is of great significance as a global strategy to eradicate viral hepatitis.

Sponsorship bias in published pharmacoeconomic evaluations of national reimbursement negotiation drugs in China: a systematic review

“…After removing duplicates, we screened 226 records and assessed 138 full-text articles based on inclusion and exclusion criteria. Eventually, 92 pharmacoeconomic evaluations were included in the review and underwent data extraction (figure 1), detailed information on included studies can be found in online supplemental table 2 19–110…”

Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C?

“…However, Gholamhoseini et al's [ 9 ] short-term simulations in Iran showed that the use of pan-genotypic regimens was cost-effective since they did not distinguish between differences in efficacy for genotypes 1 and 3 in the subgroups who used SOF/VEL. In comparison to previous studies [ 33 , 39 , 49 ], we introduced the consideration of patient attrition or discontinuation from treatment due to genetic testing and second-line treatment. We also enhanced the hepatitis C progression pathway and fine-tuned the model parameters.…”

“…The natural Markov model was constructed based on the natural history of hepatitis C [ 31 , 32 ], including five liver fibrosis states distinguished by the METAVIR fibrosis scores(F0, no fibrosis; F1, portal fibrosis without septa; F2, portal fibrosis with few septa; F3, numerous septa without fibrosis; and F4, cirrhosis), the decompensated cirrhosis state, the hepatocellular carcinoma state, the liver transplant state(first year), the post liver transplant state (> 1 year), the liver-related disease death state and the natural death state. The difference between the SVR model and the natural history model was that in the SVR model, patients in stages F0-F2 would not continue to progress in their disease state after obtaining SVR, whereas patients in stages F3 and F4 would continue progressing at a lower probability than those who do not achieve SVR [ 33 ]. Progression rates between different disease states were estimated from published meta-analyses [ 34 ], observational studies [ 35 , 36 ], and other cost-effectiveness studies [ 19 , 37 ] (Additional file 1 : Table S2).…”

“…Costs were estimated from the health system perspective, considering only direct medical costs, which included diagnosis costs, treatment costs, costs attributed to the patient’s health state, and costs for the management of serious adverse events (Additional file 1 : Table S4). The costs of hepatitis C virus testing were estimated based on public disclosure of medical service price items in 30 Chinese provinces and cities (22 provinces, 4 direct-administered municipalities, and 4 autonomous regions excluding Tibet), treatment costs were from Menet, and other costs were estimated from published literature [ 33 , 44 , 45 ]. The costs were reported in 2022 US dollars and were inflated to 2022 values using the Consumer Price Index.…”

“…Utilities were obtained from the published literature [ 33 , 46 , 47 ] and were made up of three components, including utility for each disease state in its natural state, utility after SVR, and utility during treatment (Additional file 1 : Table S4). The utility during treatment was reduced due to the presence of adverse effects during treatment [ 46 ].…”