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Sovaldi-based regimens cost-effective for certain patients with HCV genotypes 2, 3

Sovaldi-based treatment regimens were most cost-effective for treatment-experienced patients with hepatitis C virus infection genotype 2 or 3 with cirrhosis, according to newly published data in Annals of Internal Medicine.

“These new oral treatments provide better clinical results with fewer side effects for all patients, but at the current price, are only good value for those who need treatment the most — patients with advanced liver disease or those who failed prior therapy,” Benjamin P. Linas, MD, MPH, infectious disease physician and director of the HIV Epidemiology and Outcomes Research Unit at Boston Medical Center, said in a press release. “With lower costs, it would be reasonable to provide these better regimens to all patients.”

Benjamin P. Linas

Linas and colleagues used the Monte Carlo simulation model to project the costs, outcomes and cost-effectiveness of Sovaldi (sofosbuvir, Gilead Sciences)-based regimens for patients with HCV genotypes 2 and 3 and advanced liver disease. The target populations used in the analyses were patients with HCV genotypes 2 or 3, treatment-naive or treatment-experienced and who had cirrhosis or did not have cirrhosis. The researchers used data from previous published clinical trials to inform base-case treatment efficacy, disease progression, toxicity, quality of life and cost parameters, according to the research.

Overall, 4 weeks of sofosbuvir-based therapy at a cost of $28,000 extended the quality-adjusted life expectancy and was most cost-effective for treatment-experienced patients with genotypes 2 or 3 and cirrhosis.

In a base-case analysis, the incremental cost-effectiveness ratio (ICER) of sofosbuvir-based treatment was less than $100,000 per quality-adjusted life year (QALY) in patients who had cirrhosis, genotypes 2 and 3, were treatment-experienced or treatment-naive. In treatment-naive patients without cirrhosis, the ICER was more than $200,000 per QALY.

In a sensitivity analysis, the ICER for treatment-naive, non-cirrhotic patients with genotypes 2 and 3 was less than $100,000 per QALY, when the cost of sofosbuvir decreased by 40% and 60%, respectively.

Sofosbuvir-based therapy is not a cost-effective option for treatment-naive patients with genotypes 2 or 3 without cirrhosis because pegylated interferon is still an effective treatment for this population. Additionally, sustained virologic response rate benefits do not necessarily lead to increased life expectancy in patients without cirrhosis, because not every patient with HCV develops cirrhosis, according to the research. 

“Sofosbuvir provides good value for money for HCV genotype 2 and 3 treatment-experienced patients and those with cirrhosis,” the researchers wrote. “At current cost, sofosbuvir-based regimens for (genotype 2 and 3) treatment naive, non-cirrhotic patients exceed commonly cited U.S. willingness-to-pay thresholds.” – by Melinda Stevens

Disclosure: The study was funded by the National Institute on Drug Abuse and the National Institute of Allergy and Infectious Diseases. The researchers report no relevant financial disclosures.