Value in Hepatitis C Virus Treatment: A Patient-Centered Cost-Effectiveness Analysis

Abstract

Background Innovations in hepatitis C virus (HCV) therapy included in traditional comparative evaluations focus on sustained virologic response (SVR) without addressing challenges patients report beyond virologic cure. This study aims to evaluate the cost-effectiveness of HCV drug therapy with a patient-centered approach. Methods An individual-based Markov model was constructed using guidance from a stakeholder advisory board (SAB), a patient Delphi panel, and published literature to evaluate direct-acting antivirals (DAAs) compared to no treatment. The United States (US) health sector and societal perspectives were considered for 10-and 20-year time horizons. Inputs for treatment costs and effectiveness reflect a generic regimen. Indirect costs used for the societal model included estimates from self-reported productivity in a matched-control sample. Beyond the traditional quality-adjusted life-year (QALY) health outcome, this study included two novel measures developed from the Delphi panel and SAB: infected life-years and workdays missed. All costs were measured in 2018 US dollars.Results Health sector costs and QALYs were higher in the treatment group in both 10-and 20-year models. Total infected life-years and workdays missed were reduced in the treatment group for both models. When costs of absenteeism, presenteeism, and patient/ caregiver time were included, the DAA intervention was cost-saving at both 10 and 20 years. Health sector results were sensitive to drug costs and utility estimates for post-SVR health states. Societal results were sensitive to presenteeism estimates and drug costs. Conclusion Treatment was cost-effective from a health sector perspective and cost-saving when including non-health costs such as patient/caregiver time and productivity.

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

“…When the costs of absenteeism, presenteeism and patient/ BMJ Global Health caregiver time were included, the DAAs were found to be cost-saving relative to no treatment in another American study. 52 SOF-RBV was cost-effective relative to PEG-RBV in patients with genotype 2, considering costs of the productivity loss in the Japanese scenario, 53 in line with our results.…”

Stakeholder-Engaged Derivation of Patient-Informed Value Elements

“…First, while we engaged patient stakeholders from diverse medical communities, it is difficult to account for all possible patient perspectives. For example, the aspect of altruism in protecting the community from disease spread emerged in a recent study of patients with hepatitis C [26]. It may be that the fear of contagion was not prioritized in our patient-informed elements because of a lack of a patient representative from the infectious disease community.…”

Real World Cost-of-Illness Evidence in Hepatitis C Virus: A systematic review

“…When engaging HCV patients directly through qualitative interviews, advisory boards, focus groups, or Delphi panels, many patients report concerns that are difficult to measure in an observational study, such as impact on relationships, fear of harming others, financial stress, insurance issues, or stigma [54][55][56][57]. It may be difficult for researchers to accurately capture and quantify the real-world costs of some of these components reported by patients and attribute causality to HCV infection, leaving many of these constructs out of CEA designs [58]. Another area of concern for COI and CEA research in HCV was the use of list prices of drugs or hospital charges to estimate costs rather than determine an estimated net price actually paid by payers [20,32,42,47,59].…”