Curing Chronic Hepatitis C: A Cost Comparison of the Combination Simeprevir Plus Sofosbuvir vs. Protease-Inhibitor-Based Triple Therapy

• Published in: Annals of hepatology 2017-05, Vol.16 (3), p.366-374
• Main Authors: Langness, Jacob A, Tabano, David, Wieland, Amanda, Tise, Sarah, Pratt, Lindsay, Ayres Harrington, Lauren, Lin, Sonia, Ghuschcyan, Vahram, Nair, Kavita V, Everson, Gregory T
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antiviral Agents - adverse effects; Antiviral Agents - economics; Antiviral Agents - therapeutic use; Colorado; Cost-Benefit Analysis; DAA; Drug Costs; Drug Therapy, Combination; Efficacy; Female; Gastroenterology and Hepatology; Genotype; HCV; Hepacivirus - drug effects; Hepacivirus - enzymology; Hepacivirus - genetics; Hepatitis C, Chronic - diagnosis; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - economics; Hepatitis C, Chronic - virology; Humans; Male; Middle Aged; Models, Economic; Outpatient Clinics, Hospital - economics; Protease Inhibitors - adverse effects; Protease Inhibitors - economics; Protease Inhibitors - therapeutic use; Remission Induction; Simeprevir - adverse effects; Simeprevir - economics; Simeprevir - therapeutic use; Sofosbuvir - adverse effects; Sofosbuvir - economics; Sofosbuvir - therapeutic use; Sustained Virologic Response; SVR; Treatment Outcome
• ISSN: 1665-2681
• DOI: 10.5604/01.3001.0009.8591

AbstractIntroductionInterferon-free, multi-direct acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection is highly effective and well tolerated, but costly. To gain perspective on the evolving economics of HCV therapy, we compared the cost per cure of a multi-DAA regimen with the prior standard of triple therapy. Material and methodsPatients infected with HCV genotype 1 who were treated through the University of Colorado Hepatology Clinic between May 2011 and December 2014 comprised the study population. The multi-DAA regimen of simeprevir plus sofosbuvir (SMV/SOF) was compared to the triple therapy regimen consisting of peginterferon and ribavirin, with either boceprevir or telaprevir (TT). Sustained-virologic response (SVR) rates, total costs per treatment and adverse events were recorded. Total cost per SVR were compared for the two treatments, controlling for patient demographics and clinical characteristics. ResultsOne hundred eighty-three patients received SMV/SOF (n = 70) or TT (n = 113). Patients receiving SMV/SOF were older, more treatment experienced, and had a higher stage of fibrosis. SVRs were 86% and 59%, average total costs per patient were $152,775 and $95,943, and average total costs per SVR were $178,237 vs. $161,813.49 for SMV/SOF and TT groups, respectively. Medication costs accounted for 98% of SMV/SOF and 85% of TT treatment costs. ConclusionThe high cure rate of multi-DAA treatment of HCV is offset by the high costs of the DAAs, such that the cost per cure from TT to multi-DAA therapy has been relatively constant. In order to cure more patients, either additional financial resources will need to be allocated to the treatment of HCV or drug costs will need to be reduced.