Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India

• Published in: PloS one 2017-05, Vol.12 (5), p.e0176503-e0176503
• Main Authors: Aggarwal, Rakesh, Chen, Qiushi, Goel, Amit, Seguy, Nicole, Pendse, Razia, Ayer, Turgay, Chhatwal, Jagpreet
• Format: Article
• Language: English
• Subjects: Abbreviations; Adult; Analysis; Anemia; Antiviral agents; Antiviral Agents - economics; Antiviral Agents - therapeutic use; Antiviral drugs; Appendix; Biology and life sciences; C (programming language); Cancer; Care and treatment; Chronic infection; Cirrhosis; Clinical trials; Computer programming; Cost analysis; Cost engineering; Costs and Cost Analysis; Death; Decision making; Digestive tract; Documents; Dosage and administration; Drug therapy; Drugs; Drugs, Generic - economics; Drugs, Generic - therapeutic use; Economic analysis; Erythropoietin; Female; Fibrosis; Format; Gastrointestinal tract; Health care costs; Hemodialysis; Hemophilia; Hepatitis; Hepatitis B; Hepatitis C; Hepatitis C - drug therapy; Hepatocellular carcinoma; HIV; Human immunodeficiency virus; Humans; Incidence; India; Interferon; Life span; Liver cancer; Liver cirrhosis; Liver diseases; Male; Mathematical models; Medicine and health sciences; Mortality; Patient outcomes; Patients; People and Places; Programming languages; Public health; Quality of life; Regression analysis; Sensitivity analysis; Septum; Social Sciences; Statistical analysis; Systems engineering; Technology assessment; Thalassemia; Transplantation; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0176503

Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective. A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs. Model parameters were estimated from published studies. Cost-effectiveness of HCV treatment using available DAAs was calculated, using a payer's perspective. We estimated quality-adjusted life years (QALYs), disability-adjusted life years (DALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted. Compared with no treatment, the use of generic DAAs in Indian HCV patients would increase the life expectancy by 8.02 years, increase QALYs by 3.89, avert 19.07 DALYs, and reduce the lifetime healthcare costs by $1,309 per-person treated. Treatment became cost-effective within 2 years, and cost-saving within 10 years of its initiation overall and within 5 years in persons with cirrhosis. Treating 10,000 HCV-infected persons could prevent 3400-3850 decompensated cirrhosis, 1800-2500 HCC, and 4000-4550 liver-related deaths. The results were sensitive to the costs of DAAs, pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response. Treatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective.