The Cost-effectiveness, Health Benefits, and Financial Costs of New Antiviral Treatments for Hepatitis C Virus

Rein, David B.; Wittenborn, John S.; Smith, Bryce D.; Liffmann, Danielle K.; Ward, John W.

doi:10.1093/cid/civ220

Cited by 126 publications

(100 citation statements)

References 55 publications

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“…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.…”

Section: Discussionsupporting

confidence: 78%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The model includes three types of medical costs: medical management of diagnosed HCV, the costs of HCV treatment, and costs for treatment management and follow‐up. For Medicare patients, we assign annual medical management costs based on the calculation of overall medical costs attributable to HCV by stage using a two‐part log‐link “tpm” module in STATA on 2009 SEER/5% Medicare claims data, representing 407,786 Medicare beneficiaries 3, 15. Medical management costs for non‐Medicare‐insured patients are based on published estimates of attributable costs calculated for private payers 16.…”

Section: Methodsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Wittenborn

Brady

Dougherty

et al. 2017

Hepatology Communications

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We forecast the health and budgetary impact of hepatitis C (HCV) treatment on the Medicare program based on currently observed rates of treatment among Medicare and non‐Medicare patients and identify the impact of higher rates of treatment among non‐Medicare populations. We developed a computer microsimulation model to conduct an epidemiologic forecast, a budgetary impact analysis, and a cost‐effectiveness analysis of the treatment of HCV based on three scenarios: 1) no treatment, 2) continuation of current‐treatment rates, and 3) treatment rates among non‐Medicare patients increased to match that of Medicare patients. The simulated population is based on National Health and Nutrition Examination Survey data. HCV progression rates and costs were calculated in Surveillance, Epidemiology, and End Results Program Medicare 5% claims data from the Chronic Hepatitis Cohort Study and published literature. We estimate that 13.6% of patients with HCV in the United States are enrolled in Medicare, but 75% will enter Medicare in the next 20 years. Medicare patients were over 5 times as likely to be treated in 2014‐2015 as other patients. Medicare paid over $9 billion in treatment costs in both 2015 and 2016 and will total $28.4 billion from 2017‐2026. Increasing treatment rates among non‐Medicare patients would lead to 234,000 more patients being treated, reduce HCV mortality by 19%, and decrease Medicare costs by $18.6 billion from 2017‐2026. We find that treatment remains cost‐effective under most assumptions, costing $31,718 per quality adjusted life year gained. Conclusion: Medicare treats a disproportionately large share of HCV patients. Continued low rates of treatment among non‐Medicare HCV patients will result in both reduced and deferred treatment, shifting future treatment costs to Medicare while increasing overall medical management costs, morbidity, and mortality. (Hepatology Communications 2017;1:99‐109)

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wittenborn

Brady

Dougherty

et al. 2017

Hepatology Communications

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“…Számításuk szerint az egyes stratégiák mellett sorrendben 13,12-13,57-14,43-15,18 minőségi életév (QALY) várható, a SOF-kezeléstől várható a dekompezált májcirrhosis (16%) és a hepatocellularis carcinoma (HCC: 9%) előfor-dulásának legnagyobb arányú csökkenése, és ez a kezelés bizonyult legköltséghatékonyabbnak (28 800 USD per QALY) [25]. A DAA hármas kombinációk közül az AbbVie hármas kombináció, illetve Harvoni-kezelés a megfelelő HCV G1/4, illetve G2/3 fertőzött betegeknél az ismert listaárak alapján megtakarítást eredménye-zett a sofosbuvir+simeprevir, illetve sofosbuvir+ribavirin kombinációkhoz képest [26].…”

Section: Táblázatunclassified

A hepatitis C-vírus-fertőzés és kezelésének költségvonzata

Makara

Hunyady

2015

Orvosi Hetilap

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A hepatitis C-vírus-fertőzés a Föld lakosságának 2-3%-át érinti és a betegséghez társuló egyéni következmények mellett igen jelentős össztársadalmi gazdasági problémát jelent. A kiadások elsősorban a nagyszámú fel nem ismert vagy előrehaladott stádiumban felismert betegnél kialakuló májcirrhosis szövődményeihez, a hepaticus encephalopathia, az ascites, a varixvérzés és a hepatocellularis carcinoma ellátásához, valamint a májátültetéshez kapcsolódnak. Nem elhanyagolhatók ugyanakkor a munkában töltött minőségi életévek számának csökkenése miatti veszteségek, valamint a fertőzés kezelésének költségei sem. Utóbbiak az új, interferonmentes terápiák megjelenésével némiképp megemelkedtek a korábbi, proteázgátlóval együtt vagy a nélkül alkalmazott pegilált interferon plusz ribavirin terápiákhoz képest, ugyanakkor komoly megtakarítást jelenthet, hogy lényegesen kevesebb mellékhatással és ehhez kapcsolódó költséggel kell számolni. A témakörben megjelent közlemények szerint a fertőzöttek szűrőprogramokkal történő megtalálása és hatékony készítményekkel történő kezelése rövid távon jelentős többletforrást igényel, de -túl azon, hogy a legtöbbször iatrogén úton okozott betegség meggyógyítása morális társadalmi kötelesség -hosszú távon egyértelműen megtakarítást eredményez. Orv. Hetil., 2015, 156(21), 862-868. Kulcsszavak: antivirális kezelés, direkt ható antivirális szerek, hepatitis C-vírus, interferon, költséghatékonyság Financial burden of hepatitis C infection and its treatmentThe worldwide prevalence of hepatitis C infection is 2-3%. In addition to its individual consequences, it generates huge fi nancial impact on national level. In particular, lack of recognition or late diagnosis of the disease is associated with high rate of liver cirrhosis related complications (hepatic encephalopathy, ascites, variceal bleeding, hepatocellular carcinoma) and/or demands liver transplantation. Loss of quality assisted life years and/or those spent in employment, reduced work productivity, as well as costs of antiviral therapy also contribute to the fi nancial burden. The costs of new interferon-free therapies may exceed the prices of previous pegylated interferon based therapies with or without protease inhibitors; however, shorter treatment durations and extremely low rates of severe side-effects with much less related expenses can reduce total costs of these treatments. In addition to the moral obligations, published cost-effectiveness analyses conclude that early diagnosis and treatment of this primarily iatrogenic infection through organized screening programs and wide access to effective therapies may lead to long term fi nancial benefi t. Rövidítések ABT3D = ombitasvir/paritaprevir/ritonavir+dasabuvir; ASV = asunaprevir; CHC = krónikus C-vírus hepatitis; DCV = daclatasvir; F0-F4 = májfi brosis-stádiumok; G1-G7 = hepatitis C-vírus genotípusok; HCC = hepatocellularis carcinoma; HCV = hepatitis C-vírus; ICER = (incremental cost-effectiveness ratio) növekményi költséghatékonysági arány; IFN = interferon; LDV = ledipasvir; peg-IFN ...

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What is the ethical responsibility of a provider when prescribing the new direct‐acting antiviral agents to patients with hepatitis C infection?

Younossi

2015

Clinical Liver Disease

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The Cost-effectiveness, Health Benefits, and Financial Costs of New Antiviral Treatments for Hepatitis C Virus

Cited by 126 publications

References 55 publications

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

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

A hepatitis C-vírus-fertőzés és kezelésének költségvonzata

What is the ethical responsibility of a provider when prescribing the new direct‐acting antiviral agents to patients with hepatitis C infection?

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