Estimating the Allocation of the Economic Value Generated by Utilization of All-Oral Direct-Acting Antivirals for Hepatitis C in the United States, 2015-2019

Louis P Garrison; Boshen Jiao; Zizi Elsisi; Alon Yehoshua; Roy Koruth; Bruce Kreter; Jens Grueger

doi:10.1016/j.jval.2024.04.011

Estimating the Allocation of the Economic Value Generated by Utilization of All-Oral Direct-Acting Antivirals for Hepatitis C in the United States, 2015-2019

Value Health. 2024 Apr 23:S1098-3015(24)02343-X. doi: 10.1016/j.jval.2024.04.011. Online ahead of print.

Authors

Louis P Garrison¹, Boshen Jiao², Zizi Elsisi³, Alon Yehoshua⁴, Roy Koruth⁴, Bruce Kreter⁴, Jens Grueger⁵

Affiliations

¹ VeriTech Corporation, Mercer Island, WA, USA; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA. Electronic address: lgarrisn@uw.edu.
² VeriTech Corporation, Mercer Island, WA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ VeriTech Corporation, Mercer Island, WA, USA; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA.
⁴ Gilead Sciences, Inc. Foster City, CA, USA.
⁵ The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA; Boston Consulting Group Zurich, Healthcare Practice Area, Zurich, Switzerland.

PMID: 38663800
DOI: 10.1016/j.jval.2024.04.011

Abstract

Objectives: Between 2013-2019, several all-oral direct-acting antivirals (DAAs) were launched with the potential to cure patients with hepatitis C virus (HCV). They generated economic value in terms of the health gains for patients and cost-savings for the US healthcare system. We estimated the share of this value allocated to four manufacturers vs society.

Methods: For 2015-2019, we estimated the incremental impact of DAAs on HCV health outcomes and costs. We used the CDAF Polaris Observatory database to estimate utilization. Per-patient projections of lifetime quality-adjusted life-years (QALYs) gained and medical costs avoided were based on a standard 9-state HCV disease-progression model for DAA treatment vs alternatives. Annual QALY gains were valued at $114,000 per QALY. Outcomes and costs were discounted at 3%. Estimated revenues were based on reported sales.

Results: An estimated 1,080,000 patients received DAAs: 81.5% would not have received the pre-DAA standard of care. On average, these patients were projected to gain 4.4 QALYs and save $104,400 in lifetime healthcare costs, generating $531.8 billion in value. Those who would have received treatment gained 1.7 QALYs and saved $41,500 in lifetime costs, generating $47.4 billion in economic value. As treatment costs fell nearly 75%, the four manufacturers reported $37.4 billion from DAA sales-an allocation of 6.5% of the total value.

Conclusions: The great majority (∼90%) of the economic value of curing HCV with DAAs were health benefits to patients and net cost-savings to society. DAA manufacturers received a minority share (6.5%) of the aggregate economic value generated.

Keywords: antiviral therapy; budget impact analysis; cost-effectiveness analysis; economic value; hepatitis C.