Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA.
Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA.
Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Liver Center, Saga University Hospital, Saga University, Saga, Japan.
Center for Outcomes Research in Liver Diseases, Washington, DC.
Maple Health Group LLC, New York, NY.
National Center for Global Health and Medicine, Tokyo, Japan.
Hepatocellular carcinoma (HCC) is a serious complication of hepatitis B and (HBV) C virus (HCV) infection. Sustained virologic response (SVR) for HCV is associated with a reduction in cirrhosis, HCC and mortality and their associated costs. Japanese HCV patients are older with higher prevalence of HCC. Here we used a decision analytic Markov model to estimate the economic benefit of HCV cure by reducing HCC and DCC in Japan. A cohort of 10,000 HCV genotype 1b (GT1b) Japanese patients was modeled with a hybrid decision tree and Markov state-transition model capturing natural history of HCV over a lifetime horizon. Treatment options were approved all-oral direct acting antivirals (DAAs) vs. no treatment. Treatment efficacy was based on clinical trials and transition rates and costs obtained from Japan-specific data. Cases of HCC, decompensated cirrhosis (DCC) and quality-adjusted life years (QALYs) were projected for patients treated with DAAs vs. NT. QALYs were monetized using a willingness to pay threshold of ¥4-to-¥6 million. Incremental savings with treatment were calculated by adding the projected cost of complications avoided to the monetized gains in QALYs. The model showed that DAA treatment vs no therapy, reduces 2057 cases of HCC and 1478 cases of decompensated cirrhosis and saves ¥850,446.73 and ¥338,229.90 per patient (ppt). Additionally, treatment can lead to additional 2.64 QALYs gained per patient. The indirect economic gains associated with treatment-related QALY improvements were ¥10,576,000, ¥13,220,000 and ¥15,864,000 ppt (willingness to pay thresholds of ¥4 million, ¥5 million and ¥6 million). Total economic savings of treatment with DAAs (vs. no treatment) was ¥7,526,372.63, ¥10,170,372.63 and ¥12,814,372.63, at these different willingness to pay thresholds. In conclusion treatment of HCV GT1b with all oral DAAs in Japan can lead to significant direct and indirect savings related to avoidance of HCC and DCC.