1NORC at the University of Chicago, Public Health Department. 3520 Piedmont Rd. N.E., Suite 225, Atlanta, GA 30305.
2U.S. Centers for Disease Control and Prevention, Division of Viral Hepatitis, 1600 Clifton Road, Atlanta, GA 30333.
New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications increasing demand for treatment and health care costs. The cost-effectiveness of new treatments is unknown.
We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the U.S. population aged 20 and older to estimate cases identified, treated, sustained viral response (SVR); 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.
Compared to treatment with pegylated interferon, ribavirin (PR), and a protease inhibitor (PI) 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, at an incremental cost of $26.2 billion, and 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 SS/SR.
New treatments are cost-effectiveness per person treated but pent up demand for treatment may create challenges for financing.