Systematic review: DAAs provide cost-effective treatment for hepatitis C

Direct-acting antiviral (DAA) agents are cost-effective for the treatment of hepatitis C virus (HCV) genotypes 2-5, according to a new study.

The availability of DAAs has dramatically changed the landscape of HCV therapy. Understanding the value and cost-effectiveness of HCV treatment is important given the budgetary impact of treating a large number of HCV-infected individuals.

“Timely treatment of HCV with currently available DAAs is beneficial to patients as well as society because of reduced morbidity, mortality and health expenditures,” senior author Jagpreet Chhatwal PhD, assistant professor at Harvard Medical School, told Medical Economics.

The researchers published their results in the October 2017 issue of Alimentary Pharmacology & Therapeutics.

A previously published systematic review from Chhatwal and colleagues had only studied HCV genotype 1, which accounts for 46% of all infections worldwide. In the current study, they extended that analysis to HCV genotypes 2-6, which account for the remaining 54% of all infections. Genotypes 1-3 are prevalent worldwide, genotypes 4 and 5 are found mostly in Africa, and genotype 6 is principally prevalent in Asia. The study also accounts for variation in drug prices and country, among other factors.

In the new systematic review, a total of 92 incremental cost-effectiveness ratios (ICERs) for 7 different DAA regimens from 10 published articles were included. Among the abstracted 92 ICERs, 20 were for genotype 2, 40 for genotype 3, 30 for genotype 4, 2 for genotype 5 and none for genotype 6; only genotypes 2–5 were analyzed.

Next: The results

The results show that HCV treatment with available DAAs is highly cost-effective irrespective of presence of cirrhosis, prior treatment history or the region of the study if DAAs are priced at $40,000. “Furthermore, HCV treatment can be cost-saving, not merely cost-effective, if DAA prices are in the range of $17,300 to $25, 400,” said Chhatwal.

DAA regimens for treatment-naive patients with cirrhosis provided more value for money. Treatment of genotype 2 or 3 patients with DAAs had higher ICERs, although substantially below the cost-effectiveness threshold of $100,000-per-quality-adjusted life-years. The review did not find any cost-effective analysis of sofosbuvir/velpatasivr, a pan-genotype with high sustained viral response rates irrespective of HCV genotype or cirrhosis.

Chhatwal noted that there are indirect benefits of DAAs and their inclusion in modeling studies would further highlight the benefits of DAAs. In the latest systematic review, none of the studies captured indirect economic benefits, such as increased work productivity, resulting from HCV cure; none accounted for reduced HCV transmission because of HCV treatment; and none accounted for extrahepatic benefits, for example, reduced outcomes of insulin resistance and diabetes associated with successful HCV treatment. “Inclusion of these indirect benefits will make the cost-effectiveness results even look better, with higher value for the money,” he said.

The researchers concluded that “our analysis provides further evidence that widespread and timely HCV treatment would be an optimal strategy from both a public health and economic perspective. Future cost-effectiveness research should evaluate the value of HCV treatment in low-income countries, generic DAAs and new pan-genotype DAAs, and account for indirect benefits of HCV treatment.”