Francesco S Mennini1,2, Andrea Marcellusi1,2, Sarah Robbins Scott1, Simona Montilla3, Antonio Craxi4, Maria Buti5, Liana Gheorghe6, Stephen Ryder7, Loreta A Kondili8. 1. Economic Evaluation and HTA, Centre for Economic and International Studies, (EEHTA-CEIS) Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy. 2. Institute of Leadership and Management in Health, Kingston Business School, Kingston Univeristy, London, UK. 3. Department of Economic Strategy of Pharmaceutical Products, Italian Medicines Agency, Rome, Italy. 4. Gastroenterology and Hepatology Unit, Department of Internal Medicine and Medical Specialties "PROMISE", University of Palermo, Palermo, Italy. 5. Liver Unit, Hospital Universitario Valle Hebron and CIBER-EHD del Insitituto Carlos III, Barcelona, Spain. 6. Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. 7. NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK. 8. Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
Abstract
BACKGROUND AND AIMS: We assessed the clinical and economic impact of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) in England, Italy, Romania and Spain. METHODS: An HCV progression Markov model was developed considering DAA eligibility and population data during the years 2015-2019. The period of time to recover the investment in DAAs was calculated as the cost saved by avoiding estimated clinical events for 1000 standardized treated patients. A delayed treatment scenario because of coronavirus disease (COVID-19) was also developed. RESULTS: The estimated number of avoided hepatocellular carcinoma, decompensated cirrhosis and liver transplantations over a 20-year time horizon was: 1,057 in England; 1,221 in Italy; 1,211 in Romania; and 1,103 in Spain for patients treated during 2015-2016 and 640 in England; 626 in Italy; 739 in Romania; and 643 in Spain for patients treated during 2017-2019. The cost-savings ranged from € 45 to € 275 million. The investment needed to expand access to DAAs in 2015-2019 is estimated to be recovered in 6.5 years in England; 5.4 years in Italy; 6.7 years in Romania; and 4.5 years in Spain. A delay in treatment because of COVID-19 will increase liver mortality in all countries. CONCLUSION: Direct-acting antivirals have significant clinical benefits and can bring substantial cost-savings over the next 20 years, reaching a Break-even point in a short period of time. When pursuing an exit strategy from strict lockdown measures for COVID-19, providing DAAs should remain high on the list of priorities in order to maintain HCV elimination efforts.
BACKGROUND AND AIMS: We assessed the clinical and economic impact of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) in England, Italy, Romania and Spain. METHODS: An HCV progression Markov model was developed considering DAA eligibility and population data during the years 2015-2019. The period of time to recover the investment in DAAs was calculated as the cost saved by avoiding estimated clinical events for 1000 standardized treated patients. A delayed treatment scenario because of coronavirus disease (COVID-19) was also developed. RESULTS: The estimated number of avoided hepatocellular carcinoma, decompensated cirrhosis and liver transplantations over a 20-year time horizon was: 1,057 in England; 1,221 in Italy; 1,211 in Romania; and 1,103 in Spain for patients treated during 2015-2016 and 640 in England; 626 in Italy; 739 in Romania; and 643 in Spain for patients treated during 2017-2019. The cost-savings ranged from € 45 to € 275 million. The investment needed to expand access to DAAs in 2015-2019 is estimated to be recovered in 6.5 years in England; 5.4 years in Italy; 6.7 years in Romania; and 4.5 years in Spain. A delay in treatment because of COVID-19 will increase liver mortality in all countries. CONCLUSION: Direct-acting antivirals have significant clinical benefits and can bring substantial cost-savings over the next 20 years, reaching a Break-even point in a short period of time. When pursuing an exit strategy from strict lockdown measures for COVID-19, providing DAAs should remain high on the list of priorities in order to maintain HCV elimination efforts.
Authors: Andrea Marcellusi; Francesco Saverio Mennini; Murad Ruf; Claudio Galli; Alessio Aghemo; Maurizia R Brunetto; Sergio Babudieri; Antonio Craxi; Massimo Andreoni; Loreta A Kondili Journal: Liver Int Date: 2021-10-08 Impact factor: 8.754
Authors: Loreta A Kondili; Maria Buti; Mar Riveiro-Barciela; Mojca Maticic; Francesco Negro; Thomas Berg; Antonio Craxì Journal: JHEP Rep Date: 2022-07-27