The cost–effectiveness of novel direct acting antiviral agent therapies for the treatment of chronic hepatitis C

Abstract

In the USA, over 3 million individuals are infected with the HCV and 75–85% of them have or will develop chronic hepatitis C (CHC) which can lead to serious consequences such as liver cirrhosis, cancer and death. The old standard of care for the treatment of CHC was Pegylated-Interferon + Ribavirin with or without a protease inhibitor such as Boceprevir/Telaprevir. These treatments had a cure rate or rate of sustained virologic response of 66–80%. Since the close of 2013, several new direct acting antiviral agents (DAAs) for the treatment of CHC have been approved by the US FDA and have entered the US drug market. These novel CHC treatments boast very high cure rates of 80–100% and come with matching high price tags. Costs of CHC regimens that contain these novel DAAs range from $63,000 to $168,000 per treatment course. Using electronic databases, studies evaluating the cost–effectiveness of novel CHC treatments in USA were reviewed, and the reported incremental cost–effectiveness ratios based on cost per additional quality adjusted life year gained from the studies reviewed indicated that some novel DAA regimens are cost-effective; however, cost–effectiveness is contingent upon a variety of factors such as HCV genotype (1–4), presence of liver cirrhosis, patient treatment history and willingness-to-pay thresholds.

Keywords:

• cost
• cost analysis
• cost–effectiveness
• hepatitis C
• review

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Seven cost–effectiveness analysis studies were selected for review from the current literature.

• The studies included in this review analyzed the cost–effectiveness of novel direct acting antiviral agent therapies for chronic hepatitis C (CHC) in comparison to alternative novel therapies, old standard of care and/or no treatment.

• The studies included in the review analyzed the cost–effectiveness of different therapies across hepatitis C virus (HCV) genotypes 1–4.

• More cost–effectiveness research encompassing robust comparators and patient characteristics is needed in order to facilitate thorough comparison of available treatment alternatives.

• More cost–effectiveness analysis studies are needed for CHC treatment in HCV genotypes outside of genotype 1.

• The most cost-effective treatment for CHC varied across genotypes and a series of other patient characteristics.

• Sofosbuvir + Ledipasvir improved outcomes and was cost-effective across a wide array of distinct patient characteristics for HCV genotype 1 infected patients.

• There is a dearth of cost-effective treatments for Interferon-intolerant patients with CHC, especially those with HCV genotype 3 and 4 infection.