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Newer HCV medications yield health benefits at more reasonable cost
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Newer antiviral treatments for hepatitis C virus increase quality-adjusted life years compared with previous regimens, but meeting the demand for these treatments may present financial challenges, according to recent findings.
Researchers at the National Opinion Research Center at the University of Chicago and the CDC developed a simulation model of HCV among patients aged 20 years or older in the United States, stratified by age, gender and lifetime risk for injection drug use. These groups were further stratified by age into those with and without HCV antibodies; those with antibodies were subclassified as having chronic (78%) or cleared (22%) infections.
As part of the model, the researchers assumed that 25% of chronically infected patients would be either uninterested in treatment or not reachable by the health care system. Additionally, it was assumed that 18.5% of individuals born outside the 1945 to 1965 range would be offered testing, and that 100% of those within that birth cohort would be offered testing.
Of those who tested positive for HCV RNA, the researchers compared the cost-effectiveness and health outcomes of five treatment options:
- no treatment (NT);
- pegylated interferon and ribavirin (PR) for 48 weeks for HCV genotypes 1 and 4, and for 24 weeks for genotypes 2 and 3;
- PR for 24 weeks with an additional protease inhibitor (PRPI) for 12 weeks for genotypes 1 and 4, or PR for 24 weeks for genotypes 2 and 3;
- PR plus Sovaldi (PRS; sofosbuvir, Gilead Sciences) for 12 weeks for genotypes 1 and 4, sofosbuvir plus ribavirin (SR) for 12 weeks for genotype 2, and SR for 24 weeks for genotype 3; or
- Olysio (simeprevir, Janssen Therapeutics) and sofosbuvir (SS) for 12 weeks for genotypes 1 and 4, SR for 12 weeks for genotype 2, and SR for 24 weeks for genotype 3.
The researchers estimated cases identified, cases treated, SVR, deaths, medical costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) of the different therapies.
Compared with a regimen of PR and a protease inhibitor for HCV genotype 1 and PR alone for genotypes 2 and 3, treatment with PRS for genotypes 1 and 4 and treatment with SR for genotypes 2 and 3 increased QALYs by 555,226 and decreased deaths by 80,682, at an incremental cost of $26.2 billion, and an ICER of $47,304 per QALY gained.
Against a regimen of PRS/SR, the use of all-oral SS for genotypes 1 and 4 and SR for genotypes 2 and 3 increased QALYs by 1,110,451 and decreased mortality by another 164,540, at an incremental cost of $80.1 billion and an ICER of $72,169. A sensitivity analysis in which the effectiveness of SS treatment was set to the list price of two new interferon-free combinations, Viekira Pak (ombitasvir/ paritaprevir/dasabuvir/ritonavir, AbbVie) and Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) revealed treatment costs of $24,921 and $25,405 per QALY gained compared with SS/SR.
The investigators said new treatments for HCV infection promise to yield significant health benefits at a reasonable cost.
“However, financing the treatment of all Americans who could benefit from antiviral therapy will be a continuing challenge given the number of individuals who are undiagnosed, untreated, or failed to respond to older treatment regimens,” the researchers wrote. “Simply linking diagnosed patients to clinical settings in which they can be evaluated for treatment remains an ongoing challenge which is likely to reduce the potential benefits and costs of new treatments for the foreseeable future.” – by Jen Byrne
Disclosure: Rein and two other researchers report receiving unrestricted research funding related to HCV from Gilead Sciences through an award to the NORC at the University of Chicago.
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