1Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA; Center for Outcomes Research in Liver Diseases, Washington, DC.
Patients with chronic hepatitis C (CHC) exhibit reduced work productivity due to their disease. Historically, most regimens indicated for CHC genotype 1 (GT1) patients were administered with PegIFN (peginterferon) and/or RBV (ribavirin), which further compromised work productivity during treatment. The aim of this study was to model the impact of LDV/SOF (ledipasvir/sofosbuvir), the first PegIFN- and RBV-free regimen for CHC GT1 patients, on work productivity from an economic perspective, compared to receiving no treatment. The WPAI-SHP (Work Productivity and Activity Index - Specific Health Problem) questionnaire was administered to patients across the ION clinical trials (N=1,923 USA patients). Before the initiation of treatment, patients with CHC GT1 in the ION trials exhibited absenteeism and presenteeism impairments of 2.57% and 7.58%, respectively. Patients with cirrhosis exhibited greater work productivity impairment than patients without cirrhosis. 93.21% of USA patients in the ION trials achieved SVR; these patients exhibited absenteeism and presenteeism impairments of 2.62% (p=0.76 when compared to baseline) and 3.53% (p<0.0001) respectively. Monetizing these data to the entire USA population, our model projects an annual societal cost of $7.1 billion due to productivity loss in untreated GT1 CHC patients. Our model projects that, when compared to no treatment, treating all CHC GT1 patients with a regimen with very high viral eradication rates (LDV/SOF) would translate to annual productivity loss savings of $2.7 billion over a one-year time horizon.
Conclusions: Patients with untreated HCV impose a substantial societal burden due to reduced work productivity. Due to improvements in work productivity, treatment of CHC GT1 patients with LDV/SOF-based regimens is likely to result in significant cost savings from a societal perspective relative to no treatment.