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, 13 (2), e0193112
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Revisiting Policy on Chronic HCV Treatment Under the Thai Universal Health Coverage: An Economic Evaluation and Budget Impact Analysis

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Revisiting Policy on Chronic HCV Treatment Under the Thai Universal Health Coverage: An Economic Evaluation and Budget Impact Analysis

Waranya Rattanavipapong et al. PLoS One.

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Cost-effectiveness plane of lifetime cost and effectiveness of four treatment strategies.
Fig 2
Fig 2. Acceptability curves of the cost-effectiveness at the different ceiling threshold of four treatment strategies for chronic HCV infection.
Fig 3
Fig 3. Results of one-way sensitivity analysis of SOF+PEG-RBV regimen compared to standard treatment (PEG-RBV regimen).
Fig 4
Fig 4. Results of one-way sensitivity analysis of SOF+DCV regimen compared to standard treatment (PEG-RBV regimen).
Fig 5
Fig 5. Results of one-way sensitivity analysis of SOF+PEG-RBV (genotype 3) and SOF+LDV (non-3 genotype) compared to standard treatment (PEG-RBV regimen).

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References

    1. World Health Organization. Global health sector strategy on viral hepatitis, 2016–2021. Geneva: World Health Organization; 2016.
    1. Berger S. Infectious Diseases of Thailand: 2017 GIDEON Informatics2017.
    1. Messina JP, Humphreys I, Flaxman A, Brown A, Cooke GS, Pybus OG, et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology (Baltimore, Md). 2015. January;61(1):77–87. doi: 10.1002/hep.27259 . Epub 2014/07/30. eng. - DOI - PMC - PubMed
    1. Chen SL, Morgan TR. The natural history of hepatitis C virus (HCV) infection. International journal of medical sciences. 2006;3(2):47–52. . Epub 2006/04/15. eng. - PMC - PubMed
    1. World Health Organization. 20th Expert Committee on the Selection and Use of Essential Medicines Geneva2015 [cited 2016 29th December]. http://www.who.int/selection_medicines/committees/expert/20/en/.

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Grant support

HITAP is funded by the Thailand Research Fund under the senior research scholar on Health Technology Assessment (RTA5980011) to WR and RT and the Bureau of Health Policy and Strategy, Ministry of Public Health. HITAP’s international unit has been supported by the international Decision Support Initiative (funded by the Bill & Melinda Gates Foundation and the Department for International Development, UK), and the Rockefeller Foundation to provide technical assistance on health intervention and technology assessment for governments of low- and middle-income countries. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the aforementioned funding agencies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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