DAA therapies can reduce overall HCV treatment costs

New direct-acting antiviral (DAA) agents for the treatment of hepatitis C virus (HCV) provide both short-term and long-term clinical and economic value to society, according to a new study.

New all-oral DAA regimens for HCV have been shown to improve efficacy and tolerability, but there are still concerns that price may inhibit their potential as therapeutic advances, lead author Zobair Younossi MD, MPH, of the Center for Liver Diseases, Department of Medicine for Inova Fairfax Hospital in Falls Church, Virginia, told Medical Economics.  “Our new study shows that treatment is cost-effective from a societal perspective to prevent a future burden of liver cancer, transplantation and mortality,” he said.

Quality-adjusted cost of care is a practical approach for assessing whether the value of innovative therapies has been worth the cost to society. Zounossi and colleagues applied a quality-adjusted cost of care approach to establish the long-term effectiveness of approved HCV treatments as well as the therapeutic benefit and net costs of HCV treatments using the efficiency frontier for short-term effectiveness.

Quality-adjusted cost of care was defined as the increase in treatment cost minus the increase in the patient's quality-adjusted life years (QALYs) when valued at $50,000 per QALY.

Next: The results

The study compared four approved regimens in treatment-naïve genotype 1 chronic HCV patients, including pegylated interferon and ribavirin, first-generation triple therapy (boceprevir plus pegylated interferon and ribavirin and telaprevir plus pegylated interferon and ribavirin), second-generation triple therapy (sofosbuvir plus pegylated interferon and ribavirin and simeprevir plus pegylated interferon and ribavirin) and all-oral DAA regimens (ledipasvir/sofosbuvir and ombitasvir plus paritaprevir/ritonavir plus dasabuvir plus or minus ribavirin).

The results show that all-oral therapy improved the average sustained virologic response rate to 96%. This offset the high drug acquisition cost of $85,714, and resulted in the highest benefit based on the efficiency frontier. Oral therapies increased HCV drug costs by $48,350, however, associated QALY gains decreased quality-adjusted cost of care by $14,120 compared to dual therapy.

Total treatment costs decreased with all-oral treatments as compared to second-generation triple therapy. The total lifetime costs also decreased with all-oral treatments compared to any prior treatment strategy because of averted liver-disease costs.

The quality-adjusted cost of care for first-generation triple therapy increased by $423 per patient, but fell by $37,976 for second-generation triple therapy and by $95,200 for all-oral therapy. The quality-adjusted cost of care for all-oral therapy led to a reduction by $32,730, while that for first-generation and second-generation triple therapies increased by $18,072 and $1,423 per patient, respectively.

The information on efficacy and safety for the drug regimens was garnered from clinical trials rather than a real-world setting. Factors such as individual demographic characteristics, comorbidities and alcohol consumption of the individual patients treated may alter disease progression, the researchers noted.

“Society receives more benefits for the new regimens than it pays for,” said Younossi. “Treating HCV patients results in even greater value for society because of substantially improved outcomes for patients with cirrhosis.”

The researchers published the results in October 2016 Medicine.