Cost-utility analysis of second-generation direct-acting antivirals for hepatitis C: a systematic review

ABSTRACT

Introduction: High prices of second-generation direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C virus (HCV) patients led to reimbursement decisions based on cost per quality-adjusted life year (QALY).

Areas covered: We performed a systematic review of cost-utility analyses (CUA) comparing interventions with second-generation DAA therapies with no treatment, and with previous therapies for chronic HCV patients until July 2017. A total of 36 studies were included: 30 studies from the perspective of the healthcare payer, 3 from the societal perspective, and 3 did not report the perspective. For genotype 1, the highest number of ICER comparison corresponds to sofosbuvir (SOF) triple therapy and SOF-based combinations which reported a cost per QALY systematically ranging from negative to lower than US$100,000 when compared with no treatment or dual therapy or Simeprevir triple therapy.

Expert commentary: Selected studies may be overestimating the true cost per QALY of second-generation DAAs in the treatment of HCV, mainly because of neglecting non-healthcare costs, using official list prices which are higher than actual transaction prices and not adopting the long run drug price in a dynamic approach. In addition, the impact of important price reductions of several DAAs in recent years on cost per QALY should be considered.

KEYWORDS:

• Cost-effectiveness
• cost-utility
• direct acting antivirals
• hepatitis C
• quality-adjusted life years
• systematic review

Declaration of interest

L. Planellas and M. Solozabal are employed by the funding sponsor and were involved in the study design and data extraction. The authors have no other 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.

Reviewer disclosures

One reviewer has served as an advisory committee member for Gilead Sciences, and as a speaker for Bristol-Myers Squibb, Gilead Sciences and Roche. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This review was conducted as part of an unrestricted educational grant under a cooperation agreement between IQVIA and Pompeu Fabra University.