T He1, M A Lopez-Olivo2, C Hur3,4,5, J Chhatwal3,4,5. 1. Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. 2. Department of General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. 3. Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA. 4. Harvard Medical School, Boston, MA, USA. 5. Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA.
Abstract
BACKGROUND: The availability of direct-acting antivirals (DAAs) has dramatically changed the landscape of hepatitis C virus (HCV) therapy; however, the cost and budget requirements for DAA treatment have been widely debated. AIMS: To systematically review published studies evaluating the cost-effectiveness of DAAs for HCV genotype 2-6 infections, and synthesise and re-evaluate results with updated drug prices. METHODS: We conducted a systematic search of various electronic databases, including Medline, EMBASE, Cochrane library and EconLit for cost-effectiveness studies published from 2011 to 2016. Studies evaluating DAAs for genotypes 2-6 were included. Reported costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were abstracted. We re-estimated ICERs by varying the price of DAAs from $20 000 to $100 000, and estimated the threshold price at which DAA regimens would be deemed cost-effective (ICER≤$100 000/QALY). RESULTS: A total of 92 ICERs for 7 different DAA regimens from 10 published articles were included. Among the abstracted 92 ICERs, 20 were for genotype 2, 40 for genotype 3, 30 for genotype 4, 2 for genotype 5 and none for genotype 6; therefore, only genotypes 2-5 were analysed. At the discounted price of $40 000, 87.0% analyses found DAA regiments to be cost-effective, and 7.6% found to be cost-saving. The median threshold price below which DAAs would be deemed cost-effective was between $144 400 and $225 000, and cost-saving between $17 300 and $25 400. CONCLUSIONS: HCV treatment with DAAs is highly cost-effective in patients with HCV genotypes 2-5 at a $100 000/QALY threshold. Timely HCV treatment would be an optimal strategy from both a public health and economic perspective.
BACKGROUND: The availability of direct-acting antivirals (DAAs) has dramatically changed the landscape of hepatitis C virus (HCV) therapy; however, the cost and budget requirements for DAA treatment have been widely debated. AIMS: To systematically review published studies evaluating the cost-effectiveness of DAAs for HCV genotype 2-6 infections, and synthesise and re-evaluate results with updated drug prices. METHODS: We conducted a systematic search of various electronic databases, including Medline, EMBASE, Cochrane library and EconLit for cost-effectiveness studies published from 2011 to 2016. Studies evaluating DAAs for genotypes 2-6 were included. Reported costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were abstracted. We re-estimated ICERs by varying the price of DAAs from $20 000 to $100 000, and estimated the threshold price at which DAA regimens would be deemed cost-effective (ICER≤$100 000/QALY). RESULTS: A total of 92 ICERs for 7 different DAA regimens from 10 published articles were included. Among the abstracted 92 ICERs, 20 were for genotype 2, 40 for genotype 3, 30 for genotype 4, 2 for genotype 5 and none for genotype 6; therefore, only genotypes 2-5 were analysed. At the discounted price of $40 000, 87.0% analyses found DAA regiments to be cost-effective, and 7.6% found to be cost-saving. The median threshold price below which DAAs would be deemed cost-effective was between $144 400 and $225 000, and cost-saving between $17 300 and $25 400. CONCLUSIONS:HCV treatment with DAAs is highly cost-effective in patients with HCV genotypes 2-5 at a $100 000/QALY threshold. Timely HCV treatment would be an optimal strategy from both a public health and economic perspective.
Authors: D A Axelrod; M A Schnitzler; T Alhamad; F Gordon; R D Bloom; G P Hess; H Xiao; M Nazzal; D L Segev; V R Dharnidharka; A S Naik; N N Lam; R Ouseph; B L Kasiske; C M Durand; K L Lentine Journal: Am J Transplant Date: 2018-05-29 Impact factor: 8.086
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
Authors: Antoine Chaillon; Sanjay R Mehta; Martin Hoenigl; Sunil S Solomon; Peter Vickerman; Matthew Hickman; Britt Skaathun; Natasha K Martin Journal: PLoS One Date: 2019-06-06 Impact factor: 3.240
Authors: Aoran Luo; Pan Xu; Jin Wang; Zuli Li; Shunli Wang; Xiaoyan Jiang; Hong Ren; Qiang Luo Journal: Medicine (Baltimore) Date: 2019-05 Impact factor: 1.817
Authors: Huyen Anh Nguyen; Graham S Cooke; Jeremy N Day; Barnaby Flower; Le Thanh Phuong; Trinh Manh Hung; Nguyen Thanh Dung; Dao Bach Khoa; Le Manh Hung; Evelyne Kestelyn; Guy E Thwaites; Nguyen Van Vinh Chau; Hugo C Turner Journal: Wellcome Open Res Date: 2020-09-11