BACKGROUND: New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications, increasing demand for treatment and healthcare costs. The cost-effectiveness of new treatments is unknown. METHODS: We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the US population aged 20 and older to estimate cases identified, treated, sustained viral response, deaths, medical costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective. RESULTS: Compared to treatment with pegylated interferon and ribavirin (PR), and a protease inhibitor for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555 226, reduced deaths by 80 682, and increased costs by $26.2 billion at an ICER of $47 304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1 110 451 and reduced deaths by an additional 164 540 at an incremental cost of $80.1 billion and an ICER of $72 169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24 921 and $25 405 per QALY gained as compared to PRS/SR. CONCLUSIONS: New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing.
BACKGROUND: New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications, increasing demand for treatment and healthcare costs. The cost-effectiveness of new treatments is unknown. METHODS: We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the US population aged 20 and older to estimate cases identified, treated, sustained viral response, deaths, medical costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective. RESULTS: Compared to treatment with pegylated interferon and ribavirin (PR), and a protease inhibitor for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555 226, reduced deaths by 80 682, and increased costs by $26.2 billion at an ICER of $47 304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1 110 451 and reduced deaths by an additional 164 540 at an incremental cost of $80.1 billion and an ICER of $72 169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24 921 and $25 405 per QALY gained as compared to PRS/SR. CONCLUSIONS: New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing.
Authors: G Narasimhan; T N Sargios; R Kalakuntla; P Homel; D J Clain; N D Theise; H C Bodenheimer; A D Min Journal: J Viral Hepat Date: 2006-11 Impact factor: 3.728
Authors: David B Rein; John S Wittenborn; Cindy M Weinbaum; Miriam Sabin; Bryce D Smith; Sarah B Lesesne Journal: Dig Liver Dis Date: 2010-06-17 Impact factor: 4.088
Authors: M J Englesbe; J Dimick; A Mathur; Y Ads; T H Welling; S J Pelletier; D G Heidt; J C Magee; R S Sung; J D Punch; D W Hanto; D A Campbell Journal: Am J Transplant Date: 2006-12 Impact factor: 8.086
Authors: Eric Lawitz; Alessandra Mangia; David Wyles; Maribel Rodriguez-Torres; Tarek Hassanein; Stuart C Gordon; Michael Schultz; Mitchell N Davis; Zeid Kayali; K Rajender Reddy; Ira M Jacobson; Kris V Kowdley; Lisa Nyberg; G Mani Subramanian; Robert H Hyland; Sarah Arterburn; Deyuan Jiang; John McNally; Diana Brainard; William T Symonds; John G McHutchison; Aasim M Sheikh; Zobair Younossi; Edward J Gane Journal: N Engl J Med Date: 2013-04-23 Impact factor: 91.245
Authors: Erqi L Pollom; Kyueun Lee; Ben Y Durkee; Madeline Grade; Daniel A Mokhtari; Daniel R Wahl; Mary Feng; Nishita Kothary; Albert C Koong; Douglas K Owens; Jeremy Goldhaber-Fiebert; Daniel T Chang Journal: Radiology Date: 2017-01-03 Impact factor: 11.105
Authors: Harel Dahari; Laetitia Canini; Frederik Graw; Susan L Uprichard; Evaldo S A Araújo; Guillaume Penaranda; Emilie Coquet; Laurent Chiche; Aurelie Riso; Christophe Renou; Marc Bourliere; Scott J Cotler; Philippe Halfon Journal: J Hepatol Date: 2016-02-22 Impact factor: 25.083
Authors: Michael S Lyons; Vidhya A Kunnathur; Susan D Rouster; Kimberly W Hart; Matthew I Sperling; Carl J Fichtenbaum; Kenneth E Sherman Journal: Clin Infect Dis Date: 2016-02-21 Impact factor: 9.079
Authors: A Blythe Ryerson; Christie R Eheman; Sean F Altekruse; John W Ward; Ahmedin Jemal; Recinda L Sherman; S Jane Henley; Deborah Holtzman; Andrew Lake; Anne-Michelle Noone; Robert N Anderson; Jiemin Ma; Kathleen N Ly; Kathleen A Cronin; Lynne Penberthy; Betsy A Kohler Journal: Cancer Date: 2016-03-09 Impact factor: 6.860
Authors: J Chhatwal; Q Chen; T Ayer; E D Bethea; F Kanwal; K V Kowdley; X Wang; M S Roberts; S C Gordon Journal: Aliment Pharmacol Ther Date: 2018-01-29 Impact factor: 8.171