Hepatitis C, Disease and Its Management: A Cost-Effectiveness Analysis of the New Generation Oral Protease Inhibitors

Abstract

Background Hepatitis C, caused by a single stranded RNA virus, has become a global health problem. Infecting millions of individuals in the United States alone, chronic Hepatitis C viral infection can lead to devastating medical problems including cirrhosis and hepatocellular carcinoma. These problems create millions of dollars in health care costs for treatment and management. This study determines the cost effectiveness of Hepatitis C treatment with the new generation of oral protease inhibitors. Methods A Markov Model was constructed to simulate the progression of genotype 1 chronic hepatitis C disease in a cohort of 50-year-old patients. A decision tree, along with the Markov Model, was then used to determine duration of disease, treatment success, progression of disease, and mortality. At the end of each stage in the model, the cost and quality-adjusted life years (QALY) were summed for each individual. These were then used to calculate the overall cost effectiveness ratio (CER) using QALY as the unit of effectiveness. Four treatment options were modeled: Sofosbuvir with Pegylated interferon-alfa & Ribavirin (SOF/pegIFN&RBV), Sofosbuvir with Ribavirin (SOF/RBV), Simeprevir with Pegylated interferon-alfa & Ribavirin (SMV/pegINF&RBV), and Simeprevir with Sofosbuvir (SMV/SOF). Results SOF/pegIFN&RBV, yielded a CER ratio of $6,796.22/QALY, SMV/pegINF&RBV of $7,642.60/QALY, and SMV/SOF of $8,959.11/QALY. SOF/RBV had a higher CER of $16,295.30/QALY. It is important to note however that SMV/SOF had the highest QALY at 19.08. Conclusions After consideration of quality of life, treatment regimens and treatment side effects, the simeprevir and sofosbuvir regimen yields acceptable cost-effective ratios with high quality-adjusted life years.