Cost-effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus

Ann Intern Med. 2015 Mar 17;162(6):407-19. doi: 10.7326/M14-1152.

Abstract

Background: New regimens for hepatitis C virus (HCV) have shorter treatment durations and increased rates of sustained virologic response compared with existing therapies but are extremely expensive.

Objective: To evaluate the cost-effectiveness of these treatments under different assumptions about their price and efficacy.

Design: Discrete-event simulation.

Data sources: Published literature.

Target population: Treatment-naive patients infected with chronic HCV genotype 1, 2, or 3.

Time horizon: Lifetime.

Perspective: Societal.

Intervention: Usual care (boceprevir-ribavirin-pegylated interferon [PEG]) was compared with sofosbuvir-ribavirin-PEG and 3 PEG-free regimens: sofosbuvir-simeprevir, sofosbuvir-daclatasvir, and sofosbuvir-ledipasvir. For genotypes 2 and 3, usual care (ribavirin-PEG) was compared with sofosbuvir-ribavirin, sofosbuvir-daclatasvir, and sofosbuvir-ledipasvir-ribavirin (genotype 3 only).

Outcome measures: Discounted costs (in 2014 U.S. dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.

Results of base-case analysis: Assuming sofosbuvir, simeprevir, daclatasvir, and ledipasvir cost $7000, $5500, $5500, and $875 per week, respectively, sofosbuvir-ledipasvir was cost-effective for genotype 1 and cost $12 825 more per QALY than usual care. For genotype 2, sofosbuvir-ribavirin and sofosbuvir-daclatasvir cost $110 000 and $691 000 per QALY, respectively. For genotype 3, sofosbuvir-ledipasvir-ribavirin cost $73 000 per QALY, sofosbuvir-ribavirin was more costly and less effective than usual care, and sofosbuvir-daclatasvir cost more than $396 000 per QALY at assumed prices.

Results of sensitivity analysis: Sofosbuvir-ledipasvir was the optimal strategy in most simulations for genotype 1 and would be cost-saving if sofosbuvir cost less than $5500. For genotype 2, sofosbuvir-ribavirin-PEG would be cost-saving if sofosbuvir cost less than $2250 per week. For genotype 3, sofosbuvir-ledipasvir-ribavirin would be cost-saving if sofosbuvir cost less than $1500 per week.

Limitation: Data are lacking on real-world effectiveness of new treatments and some prices.

Conclusion: From a societal perspective, novel treatments for HCV are cost-effective compared with usual care for genotype 1 and probably genotype 3 but not for genotype 2.

Primary funding source: CVS Health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / economics*
  • Antiviral Agents / therapeutic use*
  • Benzimidazoles / economics
  • Benzimidazoles / therapeutic use
  • Cost-Benefit Analysis
  • Disease Progression
  • Drug Costs*
  • Drug Therapy, Combination
  • Fluorenes / economics
  • Fluorenes / therapeutic use
  • Genotype
  • Hepacivirus / genetics
  • Hepatitis C, Chronic / drug therapy*
  • Heterocyclic Compounds, 3-Ring / economics
  • Heterocyclic Compounds, 3-Ring / therapeutic use
  • Humans
  • Imidazoles / economics
  • Imidazoles / therapeutic use
  • Interferon-alpha / economics
  • Interferon-alpha / therapeutic use
  • Patient-Specific Modeling
  • Ribavirin / economics
  • Ribavirin / therapeutic use
  • Sensitivity and Specificity
  • Simeprevir
  • Sulfonamides / economics
  • Sulfonamides / therapeutic use
  • Uridine Monophosphate / analogs & derivatives
  • Uridine Monophosphate / economics
  • Uridine Monophosphate / therapeutic use

Substances

  • Antiviral Agents
  • Benzimidazoles
  • Fluorenes
  • Heterocyclic Compounds, 3-Ring
  • Imidazoles
  • Interferon-alpha
  • Sulfonamides
  • ledipasvir, sofosbuvir drug combination
  • Ribavirin
  • Simeprevir
  • Uridine Monophosphate
  • daclatasvir