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Sofosbuvir-based therapies cost-effective for patients with HCV genotypes 1, 3

Sofosbuvir-based treatment regimens were the most efficacious and cost-effective therapies in treating patients with hepatitis C virus genotype 1 and 3, according to newly published data in Annals of Internal Medicine.

“Little is known about the relative societal health benefit and value of the new treatments for hepatitis C compared with current options,” the researchers wrote. “Therefore, we conducted a cost-effectiveness analysis to evaluate the balance between health benefit and health care expenditures for these treatments under different assumptions about their price and efficacy.”

Researchers, including Mehdi Najafzadeh, PhD, MSc, MA, instructor in medicine at Harvard Medical School and an associate statistician/epidemiologist at the Brigham and Women’s Hospital, developed a discrete-event simulation model using Arena software (Rockwell Automation) to measure the history and progression of liver disease in treatment-naive patients with HCV genotypes 1, 2 or 3, from a societal perspective.

The model compared the clinical and economic outcomes of various treatment strategies among each genotype. For the patients with HCV genotype 1, researchers compared usual care composed of Victrelis (boceprevir, Merck), ribavirin and pegylated interferon with triple therapy with Sovaldi (sofosbuvir, Gilead Sciences), ribavirin and PEG and then to three PEG-free regimens: Olysio (sofosbuvir/simeprevir, Janssen Therapeutics); sofosbuvir and daclatasvir (Bristol-Myers Squibb); and Harvoni (sofosbuvir/ledipasvir, Gilead Sciences).

In patients with HCV genotype 2, researchers compared standard ribavirin and PEG with sofosbuvir/ribavirin and sofosbuvir/daclatasvir. In patients with HCV genotype 3, researchers compared dual therapy with ribavirin and PEG with sofosbuvir/ribavirin, sofosbuvir/daclatasvir and sofosbuvir/ledipasvir plus ribavirin.

The researchers based drug efficacy on sustained virologic response rates taken from previous published studies, according to the research.

Among all of the treatment regimens, sofosbuvir/ledipasvir was the most cost-effective for patients with HCV genotype 1, assuming that sofosbuvir cost $7,000 per week, simeprevir cost $5,500 per week, daclatasvir cost $5,500 per week and ledipasvir cost $875 per week. With these estimations, sofosbuvir/ledipasvir cost $12,825 more per quality-adjusted life-year (QALY) than the usual regimen of boceprevir/ribavirin/PEG.

For patients with genotype 2 in these calculations, sofosbuvir/ribavirin treatment cost $110,000 per QALY and sofosbuvir/daclatasvir cost $691,000 per QALY. In patients with genotype 3, sofosbuvir/ribavirin would cost more and was less effective than usual care; sofosbuvir/ledipasvir/ribavirin cost $73,000 per QALY and sofosbuvir/daclatasvir was more than $396,000 per QALY, according to the research.

In the sensitivity analysis, a treatment regimen of sofosbuvir/ledipasvir for patients with HCV genotype 1 was the best and most cost-saving regimen if sofosbuvir cost less than $5,500 per week; for patients with HCV genotype 2, sofosbuvir/ribavirin/PEG would be the most cost-saving if sofosbuvir was less than $2,250 per week; and for patients with HCV genotype 3, sofosbuvir/ledipasvir plus ribavirin would be the most cost-saving strategy if sofosbuvir cost less than $1,500 per week.  

“Our analysis suggests that from a societal perspective, sofosbuvir-based treatment regimens seem to represent good long-term economic value in treatment-naive patients with HCV genotypes 1 and potentially genotype 3, but not for those with genotype 2,” the researchers concluded. “If these drugs became available at lower prices, they could not only improve health outcomes but also reduce long-term health care costs.” – by Melinda Stevens

Disclosure: The study was supported by an unrestricted grant from CVS Health to Brigham and Women’s Hospital. Authors’ disclosures can be viewed online at www.acponline.org.