Cost-effectiveness of pan-genotypic direct-acting antiviral regimens for treatment of chronic Hepatitis C in the United States

ABSTRACT

Objectives

Given the goal of hepatitis C virus elimination by 2030, World Health Organization guidelines recommend treatment of chronic hepatitis C (CHC) with pan-genotypic direct-acting antivirals, such as sofosbuvir/velpatasvir (SOF/VEL), SOF/VEL/voxilaprevir (VOX) or glecaprevir/pibrentasvir (GLE/PIB). The study evaluated the cost-effectiveness of pan-genotypic regimens in initial (SOF/VEL or GLE/PIB) and re-treatment (SOF/VEL/VOX or GLE/PIB+SOF+ribavirin (RBV)) of CHC.

Methods

A Markov state-transition model projected lifetime CHC health and economic outcomes from the US payer perspective. Model inputs were sourced from clinical trials or published literature and validated by hepatologists. Model outcomes included numbers of advanced liver disease events, life-years and quality-adjusted life-years (QALYs) gained, and total lifetime costs. One-way sensitivity analyses were performed on model results.

Results

SOF/VEL followed by SOF/VEL/VOX resulted in comparable cure rates to the GLE/PIB treatment pathway (99.94% vs. 99.93%, respectively). SOF-based regimens provided similar QALYs at a lower lifetime cost versus a GLE/PIB treatment pathway ($30,749 vs. $36,255), resulting in cost savings of $5,506 per patient. Results were robust in sensitivity analyses.

Conclusion

SOF/VEL followed by SOF/VEL/VOX leads to comparable cure rates in the overall CHC population relative to the GLE/PIB treatment pathway. Based on wholesale acquisition prices, the SOF/VEL treatment pathway led to lower lifetime costs.

KEYWORDS:

• Hepatitis C
• cost-effectiveness
• cost-utility
• health outcomes

Acknowledgments

Health economic model construction and medical writing support were provided by Rob Blissett, Filipa Aragao and Rachel Beckerman of Maple Health Group, LLC (New York, NY, USA) and funded by Gilead Sciences Inc.

Article Highlights

• The World Health Organization has stated a goal of hepatitis C virus elimination by 2030; its guidelines recommend treatment of chronic hepatitis C with pan-genotypic direct-acting antivirals.

• A Markov state-transition model projected lifetime CHC health and economic outcomes from the US payer perspective using inputs sourced from clinical trials or published literature and validated by hepatologists.

• SOF/VEL followed by SOF/VEL/VOX resulted in comparable cure rates to the GLE/PIB treatment pathway (99.94% vs. 99.93%, respectively).

• SOF-based regimens provided similar QALYs at a lower lifetime cost versus a GLE/PIB treatment pathway ($30,749 vs. $36,255), resulting in cost savings of $5,506 per patient, based on wholesale acquisition costs.

Declaration of interest

S Gordon has served as a speaker and lecturer for Dova Pharmaceuticals, as an advisory board member for Dova Pharmaceutical and Intercept, and has received research funding from AbbVie Pharmaceuticals, Conatus, CymaBay, Gilead Sciences, Intercept, and Merck. NJ Smith has served as a consultant for Gilead Sciences. J Lee is an employee of Gilead Sciences and owns stocks and shares in Gilead Sciences. DT Dieterich received consulting and speaking fees from Gilead, Merck and BMS.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

All authors contributed equally to the development and review of this manuscript.

All authors approved the final version of the manuscript, including the authorship list, and agree to be accountable for all aspects of the work.

Supplementary material

supplemental data for this article can be accessed here

Additional information

Funding

This study was funded by Gilead Sciences Inc., Foster City, CA, USA.