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

Abstract

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.

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

“…Currently, more than 100 countries around the world have benefited from the license agreements, including a majority of LMICs. 62 Our study findings are in accordance with several studies conducted in Asian countries, including a study of Rattanavipapong 63 in Thailand, where SOF/LDV and SOF+DCV regimens were cost-saving compared with PR, and another study of Igarashi 64 in Japan, where SOF/LDV was also found to be cost-saving compared with PR. Some other studies that compared DAA regimens to no treatment also reported the cost-saving result of DAA regimens, including a study of Aggarwal 65 in India on SOF/LDV and SOF+DCV, and another study of Goel 66 in India on SOF/VEL.…”

Knowledge, attitude, and behaviors toward liver health and viral hepatitis-related liver diseases in Thailand

“…This could account for the finding that 35.6% had perceived health screening tests as expensive. It was also interesting to note that more than half cited that “prescription medicine is expensive” as a reason for not receiving treatment when treatment costs incurred under these health insurance schemes are covered by the Thai government [10,31] . Although antiviral therapy for CHB has been covered by all health insurance schemes for a long time, oral antiviral therapy for CHC is recently covered this year as part of the viral hepatitis eradication goals in Thailand [33] .…”

“…It was also interesting to note that more than half cited that "prescription medicine is expensive" as a reason for not receiving treatment when treatment costs incurred under these health insurance schemes are covered by the Thai government. [10,31] Although antiviral therapy for CHB has been covered by all health insurance schemes for a long time, oral antiviral therapy for CHC is recently covered this year as part of the viral hepatitis eradication goals in Thailand. [33] This potentially suggests that There was a similar proportion of individuals receiving hepatitis treatment in the form of prescription medication (59.1%) and functional foods (51.8%).…”

“…[ 2 , 7 ] The advent of HCV treatment regimens such as direct acting antivirals (DAAs) also reportedly resulted in a significant reduction in HCV global incidence and associated complications. [ 8 , 9 ] The introduction of these regimens, especially interferon-free DAAs regimen, as part of Thailand's Universal Health Care's benefit package [ 10 ] together with an increased awareness and precautionary measures against blood-borne pathogens such as human immunodeficiency virus (HIV) and changes in intravenous drug use-oral illicit methamphetamine usage [ 2 , 11 ] could potentially contribute to the nation's decreasing HCV prevalence.…”

Wer profitiert von medizinisch-technischen Innovationen?

“…Therapeutische Neuerungen in der Medizin sind häufig zu Beginn ihrer Implementierung mit höheren Kosten verbunden [5,7,13,19]. Insbesondere stehen die direkten Kosten des neuen Implantats bzw.…”