Ilanca Fraser1, Johanita Burger2, Martie Lubbe1, George Dranitsaris3, Mark Sonderup4, Tienie Stander5. 1. Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa. 2. Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa. johanita.burger@nwu.ac.za. 3. Augmentium Pharma Consulting Inc., Toronto, ON, Canada. 4. Department of Medicine and Division of Hepatology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. 5. HEXOR (Pty) Ltd., Midrand, Gauteng, South Africa.
Abstract
BACKGROUND: The recently launched nucleotide polymerase inhibitor sofosbuvir represents a significant turn in the treatment paradigm of chronic hepatitis C. While effective, sofosbuvir is also associated with a considerable cost. OBJECTIVE: The objective of this study was to evaluate the cost effectiveness of sofosbuvir-containing regimens in treatment-naive patients with chronic hepatitis C virus (HCV) genotype 5 (HCV-G5) mono-infection in South Africa (SA). DESIGN: We constructed a lifetime horizon decision-analytic Markov model of the natural history of HCV infection to evaluate the cost effectiveness of sofosbuvir-ledipasvir (SOF/LDV) monotherapy against sofosbuvir triple therapy (SOF-TT) (sofosbuvir + pegylated interferon and ribavirin [peg-INF/RBV]) and the current standard of care (SOC) (peg-INF/RBV) for patients with chronic HCV-G5 in the South African context. The model was populated with data from published literature, expert opinion and South African private sector cost data. The price modelled for sofosbuvir was the predicted South African private sector price of 82,129.32 South African rand (R) (US$7000) for 12 weeks. The analysis was conducted from a third-party payer perspective. OUTCOME MEASURES: The outcome measures were discounted and undiscounted costs (in 2015 South African rand and US dollars) and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS: Outcomes from the cost-effectiveness model show that SOF/LDV yields the most favourable future health economic outcomes compared with SOF-TT and the current SOC in SA. Findings relating to the lifetime incremental cost per QALY gained for patients infected with HCV-G5 indicate that SOF/LDV dominated both SOF-TT and SOC, i.e. SOF/LDV is less costly and more effective. CONCLUSION: Outcomes from this analysis suggest that at a price of R123,190 ($US10,500) for 12 weeks of SOF/LDV might be cost effective for South African patients infected with HCV-G5.
BACKGROUND: The recently launched nucleotide polymerase inhibitor sofosbuvir represents a significant turn in the treatment paradigm of chronic hepatitis C. While effective, sofosbuvir is also associated with a considerable cost. OBJECTIVE: The objective of this study was to evaluate the cost effectiveness of sofosbuvir-containing regimens in treatment-naive patients with chronic hepatitis C virus (HCV) genotype 5 (HCV-G5) mono-infection in South Africa (SA). DESIGN: We constructed a lifetime horizon decision-analytic Markov model of the natural history of HCV infection to evaluate the cost effectiveness of sofosbuvir-ledipasvir (SOF/LDV) monotherapy against sofosbuvir triple therapy (SOF-TT) (sofosbuvir + pegylated interferon and ribavirin [peg-INF/RBV]) and the current standard of care (SOC) (peg-INF/RBV) for patients with chronic HCV-G5 in the South African context. The model was populated with data from published literature, expert opinion and South African private sector cost data. The price modelled for sofosbuvir was the predicted South African private sector price of 82,129.32 South African rand (R) (US$7000) for 12 weeks. The analysis was conducted from a third-party payer perspective. OUTCOME MEASURES: The outcome measures were discounted and undiscounted costs (in 2015 South African rand and US dollars) and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS: Outcomes from the cost-effectiveness model show that SOF/LDV yields the most favourable future health economic outcomes compared with SOF-TT and the current SOC in SA. Findings relating to the lifetime incremental cost per QALY gained for patients infected with HCV-G5 indicate that SOF/LDV dominated both SOF-TT and SOC, i.e. SOF/LDV is less costly and more effective. CONCLUSION: Outcomes from this analysis suggest that at a price of R123,190 ($US10,500) for 12 weeks of SOF/LDV might be cost effective for South African patients infected with HCV-G5.
Authors: Nathan Ford; Kasha Singh; Graham S Cooke; Edward J Mills; Tido von Schoen-Angerer; Adeeba Kamarulzaman; Philipp du Cros Journal: Clin Infect Dis Date: 2012-03-19 Impact factor: 9.079
Authors: Priscilla C Hsu; Mel Krajden; Eric M Yoshida; Frank H Anderson; George A Tomlinson; Murray D Krahn Journal: Liver Int Date: 2009-03 Impact factor: 5.828
Authors: Michael J Sweeting; Daniela De Angelis; Keith R Neal; Mary E Ramsay; William L Irving; Mark Wright; Lisa Brant; Helen E Harris Journal: J Clin Epidemiol Date: 2006-02 Impact factor: 6.437
Authors: Andrew J Leidner; Harrell W Chesson; Philip R Spradling; Scott D Holmberg Journal: Appl Health Econ Health Policy Date: 2017-02 Impact factor: 2.561
Authors: Margaret Hellard; Sophia E Schroeder; Alisa Pedrana; Joseph Doyle; Campbell Aitken Journal: Cold Spring Harb Perspect Med Date: 2020-04-01 Impact factor: 6.915
Authors: Robert Hecht; Lindsey Hiebert; Wendy C Spearman; Mark W Sonderup; Teresa Guthrie; Timothy B Hallett; Shevanthi Nayagam; Homie Razavi; Shan Soe-Lin; Kgomotso Vilakazi-Nhlapo; Yogan Pillay; Stephen Resch Journal: Health Policy Plan Date: 2018-05-01 Impact factor: 3.344
Authors: Winnie de Bruijn; Cristina Ibáñez; Pia Frisk; Hanne Bak Pedersen; Ali Alkan; Patricia Vella Bonanno; Ljiljana S Brkičić; Anna Bucsics; Guillaume Dedet; Jaran Eriksen; Joseph O Fadare; Jurij Fürst; Gisselle Gallego; Isabella P Godói; Augusto A Guerra Júnior; Hakkı Gürsöz; Saira Jan; Jan Jones; Roberta Joppi; Saim Kerman; Ott Laius; Newman Madzikwa; Einar Magnússon; Mojca Maticic; Vanda Markovic-Pekovic; Amos Massele; Olayinka Ogunleye; Aisling O'Leary; Jutta Piessnegger; Catherine Sermet; Steven Simoens; Celda Tiroyakgosi; Ilse Truter; Magnus Thyberg; Kristina Tomekova; Magdalena Wladysiuk; Sotiris Vandoros; Elif H Vural; Corinne Zara; Brian Godman Journal: Front Pharmacol Date: 2016-07-22 Impact factor: 5.810