DAA treatment for HCV can be cost saving

In addition to preventing premature death, treatment of hepatitis C with direct-acting antiviral agents can be significantly cost-saving for many countries, researchers reported at the Liver Meeting Digital Experience.

“Hepatitis C treatment uptake in most countries remains low due to high drug prices and limited budgets for treating large hepatitis C-infected populations. Due to this, we wanted to look at what price and timeframe does direct-acting antiviral treatment become cost saving,” Madeline Adee, MPH, from Massachusetts General Hospital, said during a virtual presentation.

Adee and colleagues used a previously validated microsimulation model to simulate disease progression in a cohort of patients with HCV in 158 countries. They then adapted to the costs and HCV epidemiology of each country and compared outcomes with direct-acting antiviral (DAA) treatment vs. no treatment.

Varied cost-saving price thresholds

In their analysis, the researchers found that the median price thresholds at which DAA becomes cost saving in 5 years were lowest in sub-Saharan Africa and south Asia and highest in Europe, central Asia and North America.

Adee and colleagues also divided the countries into four income groups and assessed what DAA price achieves cost savings in 5 years, 10 years or lifetime. They found that, on average, threshold prices increased as income increased, with median threshold prices for different income groups varying substantially. Specifically, the median threshold price was $64 for low-income countries, $156 for lower-middle-income countries, $665 for upper-middle-income countries and $3,682 for high-income countries.

Notably, some countries have achieved a price that is below the 5-year cost savings threshold price and several have achieved a price that is within the 10-year or lifetime horizon price, Adee said.

The researchers also assessed how the cost saving prices compared with actual health expenditure budgets in each of the countries studied. The DAA threshold price for 5-year cost savings again increased as income increased, as did the budget to treat the viremic population at the percentage of annual expenditures. India, however, was an outlier on the lower spectrum of annual health care budget with a cost to treat 10% of the viremic population being only 0.02% of the country’s annual health expenditures, Adee noted.

The percent of health expenditure to treat 10% of the viremic population at the 5-year cost saving price varied with income, with the median percentages being 0.1%, 0.3%, 0.5% and 2.4% for low-income, lower-middle-income, upper-middle-income and high-income groups, respectively. The researchers noted, however a significant amount of range in this percentage within each income group. The most pronounced range occurred in the high-income group, with the median percentage ranging from 0.3% to 245.4%, according to Adee.

Time to cost saving

Additionally, because several countries can procure DAA at or below $90 per treatment course through the United Nations Development Program, Adee and colleagues wanted to estimate the time horizon in which HCV treatment becomes cost saving at that price.

For all 158 countries in the analysis, time to cost saving varied between 0.28 and 17.29 years, with a median of 1.08 years, according to the analysis. All high-income countries would achieve cost savings in less than a year and most countries would achieve cost savings in less than 5 years. High-income countries would achieve this the fastest while low-income countries would achieve this the slowest, Adee noted.

Overall, these results indicated that HCV treatment can prove financially beneficial relatively quickly, according to Adee.

“At the current HCV treatment price, some countries can recover 100% of their treatment expenditures in just 5 years by treating HCV, not to mention many premature deaths would be prevented by this,” Adee said. “Our analysis can help inform price negotiations and budget planning for scaling up HCV treatment. Upfront costs needed to achieve this treatment globally vary substantially between countries, which highlights differences in feasibility of achieving this treatment target, even at cost saving DAA prices.”