Cost-effectiveness of the highly effective direct-acting antivirals in the treatment of chronic hepatitis C in Hong Kong

• Published in: Journal of gastroenterology and hepatology 2017-05, Vol.32 (5), p.1071-1078
• Main Authors: Lo, Angeline Oi-Shan, Chan, Henry Lik-Yuen, Wong, Vincent Wai-Sun, Wong, Grace Lai-Hung
• Format: Article
• Language: English
• Subjects: Antiviral agents; Antiviral Agents - administration & dosage; Antiviral Agents - economics; Cost analysis; Cost-Benefit Analysis; Drug Combinations; Genotype; Hepacivirus - genetics; Hepatitis; Hepatitis C; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - economics; Hepatitis C, Chronic - virology; Hong Kong; Humans; Interferon; Interferon-alpha - administration & dosage; Interferon-alpha - economics; Liver; Markov Chains; Middle Aged; Polyethylene Glycols - administration & dosage; Polyethylene Glycols - economics; Proline - administration & dosage; Proline - analogs & derivatives; Proline - economics; Quality-Adjusted Life Years; Recombinant Proteins - administration & dosage; Recombinant Proteins - economics; Ribavirin; Ribavirin - administration & dosage; Ribavirin - economics; Sofosbuvir - administration & dosage; Sofosbuvir - economics; Treatment Outcome
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.13638

In Asia-Pacific where cost is a major concern, peginterferon plus ribavirin (PR) often remain as the standard of care in chronic hepatitis C (CHC) treatment, while the direct-acting antivirals (DAAs) are commonly recommended as retreatment. Newer DAAs can achieve a sustained virological response (SVR) of nearly 100% with pan-genotypic coverage, that is "Highly Effective DAAs." We aimed to investigate the most desirable cost range for the Highly Effective DAAs using Hong Kong as an example. Markov modeling was performed using PR as the reference strategy. The cost-effectiveness of the Highly Effective DAAs was compared with sofosbuvir-PR (first-line and rescue) and boceprevir-PR therapies. A 50-year-old genotype 1b hepatitis C virus (HCV) infected treatment-naïve patient with METAVIR F3 was used as the base case scenario to reflect the commonest HCV genotype in Hong Kong. The use of PR would incur a lifetime cost of US$35,854 and effectiveness of 14.85 quality-adjusted life-year (QALY). Sofosbuvir-PR as first-line treatment was dominated by other regimes. If Sofosbuvir-PR rescue therapy was used, the drug cost of Highly Effective DAAs should be set below US$43,553, with a cost-effectiveness ratio (CER) of US$3035/QALY compared with PR. In regions where Boceprevir-PR was still used as first-line therapy, the desirable drug cost of Highly Effective DAAs would be below US$56,985 to achieve a CER of US$5427/QALY. The most desirable costs of the Highly Effective DAAs would be below US$43,553 if Sofosbuvir-PR rescue therapy is used and below US$56,985 if Boceprevir-PR therapy is used.