A Cost-Effectiveness Analysis of Shortened Direct-Acting Antiviral Treatment in Genotype 1 Noncirrhotic Treatment-Naive Patients With Chronic Hepatitis C Virus

Value Health. 2019 Jun;22(6):693-703. doi: 10.1016/j.jval.2018.12.011. Epub 2019 May 17.

Abstract

Background: Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs.

Objectives: To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients.

Methods: Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies.

Results: The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course.

Conclusions: Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective.

Keywords: cost-effectiveness; direct-acting antivirals; hepatitis C virus; shortened treatment duration.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / economics*
  • Antiviral Agents / therapeutic use
  • Carbamates / economics
  • Carbamates / therapeutic use
  • Cost-Benefit Analysis
  • Decision Trees
  • Hepacivirus / drug effects
  • Hepacivirus / pathogenicity
  • Hepatitis C, Chronic / drug therapy*
  • Heterocyclic Compounds, 4 or More Rings / economics
  • Heterocyclic Compounds, 4 or More Rings / therapeutic use
  • Humans
  • Macrocyclic Compounds / economics
  • Macrocyclic Compounds / therapeutic use
  • Markov Chains
  • Sofosbuvir / economics
  • Sofosbuvir / therapeutic use
  • State Medicine / organization & administration
  • State Medicine / statistics & numerical data
  • Sulfonamides / economics
  • Sulfonamides / therapeutic use
  • United Kingdom

Substances

  • Antiviral Agents
  • Carbamates
  • Heterocyclic Compounds, 4 or More Rings
  • Macrocyclic Compounds
  • Sulfonamides
  • voxilaprevir
  • velpatasvir
  • Sofosbuvir