Economic evaluation of pegylated interferon plus ribavirin for treatment of chronic hepatitis C in Thailand: genotype 1 and 6

Kapol, Nattiya; Lochid-amnuay, Surasit; Teerawattananon, Yot

doi:10.1186/s12876-016-0506-4

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…Studies in neighboring countries have reported the cost of Peg-IFN using the same doses. One study from Thailand reported that the Peg IFN-2a/2b and ribavirin for treating HCV genotypes 1/6 cost US$90 per week (2013 prices) 30 , which is similar to our finding. Another study reported that in China 31 , the Peg IFN-2a and ribavirin for treating HCV genotype 1, cost US$174 per week (2016 prices), almost double our estimate.…”

Section: Discussionsupporting

confidence: 90%

“…Whilst it is possible that there may be some minor variations in costs in other provinces in Vietnam, as the costs of both healthcare services and drugs are regulated centrally by the NHI department and MoH, our cost estimates are likely to be robust. Although the precise results and cost estimates of our study are not directly generalizable to other countries, they are consistent with reports from neighbouring countries, such as Thailand 30 . It is important that further HCV treatment costing studies are conducted in other low- and middle-income countries, particularly relating to the use of DAAs.…”

Section: Discussionsupporting

confidence: 82%

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The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam

et al. 2020

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Background: Injectable interferon-based therapies have been used to treat hepatitis C virus (HCV) infection since 1991. International guidelines have now moved away from interferon-based therapy towards direct-acting antiviral (DAA) tablet regimens, because of their superior efficacy, excellent side-effect profiles, and ease of administration. Initially DAA drugs were prohibitively expensive for most healthcare systems. Access is now improving through the procurement of low-cost, generic DAAs acquired through voluntary licenses. However, HCV treatment costs vary widely, and many countries are struggling with DAA treatment scale-up. This is not helped by the limited cost data and economic evaluations from low- and middle-income countries to support HCV policy decisions. We conducted a detailed analysis of the costs of treating chronic HCV infection with interferon-based therapy in Vietnam. Understanding these costs is important for performing necessary economic evaluations of novel treatment strategies. Methods: We conducted an analysis of the direct medical costs of treating HCV infection with interferon alpha (IFN) and pegylated-interferon alpha (Peg-IFN), in combination with ribavirin, from the health sector perspective at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, in 2017. Results: The total cost of the IFN treatment regimen was estimated to range between US$1,120 and US$1,962. The total cost of the Peg-IFN treatment regimen was between US$2,156 and US$5,887. Drug expenses were the biggest contributor to the total treatment cost (54-89%) and were much higher for the Peg-IFN regimen. Conclusions: We found that treating HCV with IFN or Peg-IFN resulted in significant direct medical costs. Of concern, we found that all patients incurred substantial out-of-pocket costs, including those receiving the maximum level of support from the national health insurance programme. This cost data highlights the potential savings and importance of increased access to generic DAAs in low- and middle-income countries and will be useful within future economic evaluations.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 82%

The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam

et al. 2020

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“…Health outcomes were expressed in terms of quality adjusted life years (QALYs). The structure of the model was based from the previous model of hepatitis C treatment recommendation in Thailand [ 8 ] which was modified to include anemia–the most common adverse event in treating chronic hepatitis C.…”

Section: Methodsmentioning

confidence: 99%

“…Transitional probabilities between health states were obtained from previously published economic evaluation [ 8 ]. To acquire probabilities of treatment-associated anemia, data from previous studies were reviewed through meta-analysis using STATA version 14.…”

Section: Methodsmentioning

confidence: 99%

Revisiting policy on chronic HCV treatment under the Thai Universal Health Coverage: An economic evaluation and budget impact analysis

2018

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Thailand is encountering challenges to introduce the high-cost sofosbuvir for chronic hepatitis C treatment as part of the Universal Health Care’s benefit package. This study was conducted in respond to policy demand from the Thai government to assess the value for money and budget impact of introducing sofosbuvir-based regimens in the tax-based health insurance scheme. The Markov model was constructed to assess costs and benefits of the four treatment options that include: (i) current practice–peginterferon alfa (PEG) and ribavirin (RBV) for 24 weeks in genotype 3 and 48 weeks for other genotypes; (ii) Sofosbuvir plus peginterferon alfa and ribavirin (SOF+PEG-RBV) for 12 weeks; (iii) Sofosbuvir and daclatasvir (SOF+DCV) for 12 weeks; (iv) Sofosbuvir and ledipasvir (SOF+LDV) for 12 weeks for non-3 genotypes and SOF+PEG-RBV for 12 weeks for genotype 3 infection. Given that policy options (ii) and (iii) are for pan-genotypic infection, the cost of genotype testing was applied only for policy options (i) and (iv). Results reveal that all sofosbuvir-based regimens had greater quality adjusted life years (QALY) gains compared with the current treatment, therefore associated with lower lifetime costs and more favourable health outcomes. Additionally, among the three regimens of sofosbuvir, SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype are the most cost-effective treatment option with the threshold of 160,000 THB per QALY gained. The results of this study had been used in policy discussion which resulted in the recent inclusion of SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype in the Thailand’s benefit package.

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“…A hybrid of decision-tree and Markov models adapted from Kapol et al 23 was applied, which was validated by clinical experts in Vietnam’s National Hospital of Tropical Diseases.…”

Section: Methodsmentioning

confidence: 99%

Cost-Utility Analysis of Direct-Acting Antivirals for Treatment of Chronic Hepatitis C Genotype 1 and 6 in Vietnam

Thakkinstian¹,

Thavorncharoensap

Sobhonslidsuk

et al. 2020

Value in Health

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Objective Very few cost-utility analyses have either evaluated direct-acting antivirals (DAAs) on hepatitis C virus (HCV) genotype 6 patients or undertaken societal perspective. Recently, DAAs have been introduced into the Vietnamese health insurance drug list for chronic hepatitis C (CHC) treatment without empirical cost-effectiveness evidence. This study was conducted to generate these data on DAAs among CHC patients with genotypes 1 and 6 in Vietnam. Methods A hybrid decision-tree and Markov model was employed to compare costs and quality-adjusted life-years (QALYs) of available DAAs, including (1) sofosbuvir/ledipasvir, (2) sofosbuvir/velpatasvir, and (3) sofosbuvir plus daclatasvir, with pegylated-interferon plus ribavirin (PR). Primary data collection was conducted in Vietnam to identify costs and utility values. Incremental cost-effectiveness ratios were estimated from societal and payer perspectives. Uncertainty and scenario analyses and value of information analyses were performed. Results All DAAs were cost-saving as compared with PR in CHC patients with genotypes 1 and 6 in Vietnam, and sofosbuvir/velpatasvir was the most cost-saving regimen, from both societal and payer perspectives. From the societal perspective, DAAs were associated with the increment of quality-adjusted life-years by 1.33 to 1.35 and decrement of costs by $6519 to $7246. Uncertainty and scenario analyses confirmed the robustness of base-case results, whereas the value of information analyses suggested the need for further research on relative treatment efficacies among DAA regimens. Conclusions Allocating resources for DAA treatment for HCV genotype 1 and 6 is surely a rewarding public health investment in Vietnam. It is recommended that the government rapidly scale up treatment and enable financial accessibility for HCV patients.

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Economic evaluation of pegylated interferon plus ribavirin for treatment of chronic hepatitis C in Thailand: genotype 1 and 6

Cited by 8 publications

References 28 publications

The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam

The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam

Revisiting policy on chronic HCV treatment under the Thai Universal Health Coverage: An economic evaluation and budget impact analysis

Cost-Utility Analysis of Direct-Acting Antivirals for Treatment of Chronic Hepatitis C Genotype 1 and 6 in Vietnam

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