Cost-effectiveness of increased screening and treatment of chronic hepatitis C in Korea

Abstract

Background

Given a hepatitis C virus (HCV) elimination goal by 2030, World Health Organization (WHO) guidelines recommend scaling up HCV screening and treatment with highly-effective direct-acting antivirals (DAAs). This study investigated the cost-effectiveness of various screening and treatment strategies for chronic HCV patients in South Korea in patients aged over 40 as compared to currently screening only high-risk patients.

Methods

A published Markov disease progression model was used with a screening/treatment decision-tree to model different screening and treatment strategies for Korean HCV patients (aged over 40) from a national payer perspective over a lifetime time horizon. The screening strategies included “screen-all” (upfront only: “once”; or upfront and age 65: “twice”) or a “high-risk only” screening strategy followed by treatment. Treatment strategies included either ledipasvir/sofosbuvir (LDV/SOF), SOF + ribavirin (SOF + RBV; in GT2 only), or glecaprevir/pibrentasvir (GLE/PIB). Model inputs were sourced from published literature and costing databases and validated by Korean hepatologists.

Results

Regardless of treatment strategy, a “screen all twice” scenario led to the lowest rates of advanced liver disease events compared to “screen all once” and “high-risk only” screening scenarios. In this screening scenario, treatment with LDV/SOF for GT1/2 dominates (i.e. is more effective and less4costly) LDV/SOF in GT1 and SOF + RBV in GT2, while GLE/PIB is not cost-effective relative to LDV/SOF (₩105,124,920/QALY) at a willingness-to-pay threshold of 1xGDP per capita.

Conclusion

Screening all South Korean patients twice followed by LDV/SOF treatment is cost-effective as compared current high-risk screening. Adopting this strategy can help achieve WHO HCV elimination goals.

Keywords:

• Hepatitis C
• cost-effectiveness
• cost-utility
• ledipasvir/sofosbuvir
• glecaprevir/pibrentasvir
• South Korea

Transparency

Declaration of funding

This study was funded by Gilead Sciences.

Declaration of financial/other relationships

DYK and HJK received grant funding from Gilead Sciences, Inc. GW, JL, and MHK are employees of Gilead Sciences, Inc. NS and RB received consulting fees from Gilead Sciences, Inc. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

None reported.