title: Cost-effectiveness of novel regimens for the treatment of hepatitis C virus.
abstract: BACKGROUND
  New regimens for hepatitis C virus (HCV) have shorter treatment durations and increased rates of sustained virologic response compared with existing therapies but are extremely expensive.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of these treatments under different assumptions about their price and efficacy.
  
  
  METHODS
  Discrete-event simulation.
  
  
  METHODS
  Published literature.
  
  
  METHODS
  Treatment-naive patients infected with chronic HCV genotype 1, 2, or 3.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  Usual care (boceprevir-ribavirin-pegylated interferon [PEG]) was compared with sofosbuvir-ribavirin-PEG and 3 PEG-free regimens: sofosbuvir-simeprevir, sofosbuvir-daclatasvir, and sofosbuvir-ledipasvir. For genotypes 2 and 3, usual care (ribavirin-PEG) was compared with sofosbuvir-ribavirin, sofosbuvir-daclatasvir, and sofosbuvir-ledipasvir-ribavirin (genotype 3 only).
  
  
  METHODS
  Discounted costs (in 2014 U.S. dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
  
  
  RESULTS
  Assuming sofosbuvir, simeprevir, daclatasvir, and ledipasvir cost $7000, $5500, $5500, and $875 per week, respectively, sofosbuvir-ledipasvir was cost-effective for genotype 1 and cost $12 825 more per QALY than usual care. For genotype 2, sofosbuvir-ribavirin and sofosbuvir-daclatasvir cost $110 000 and $691 000 per QALY, respectively. For genotype 3, sofosbuvir-ledipasvir-ribavirin cost $73 000 per QALY, sofosbuvir-ribavirin was more costly and less effective than usual care, and sofosbuvir-daclatasvir cost more than $396 000 per QALY at assumed prices.
  
  
  RESULTS
  Sofosbuvir-ledipasvir was the optimal strategy in most simulations for genotype 1 and would be cost-saving if sofosbuvir cost less than $5500. For genotype 2, sofosbuvir-ribavirin-PEG would be cost-saving if sofosbuvir cost less than $2250 per week. For genotype 3, sofosbuvir-ledipasvir-ribavirin would be cost-saving if sofosbuvir cost less than $1500 per week.
  
  
  CONCLUSIONS
  Data are lacking on real-world effectiveness of new treatments and some prices.
  
  
  CONCLUSIONS
  From a societal perspective, novel treatments for HCV are cost-effective compared with usual care for genotype 1 and probably genotype 3 but not for genotype 2.
  
  
  BACKGROUND
  CVS Health.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Najafzadeh
authors.forename: Karin
authors.initials: K
authors.lastname: Andersson
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Krumme
authors.forename: Olga S
authors.initials: OS
authors.lastname: Matlin
authors.forename: Troyen
authors.initials: T
authors.lastname: Brennan
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use; D002219:Carbamates; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005449:Fluorenes / Q000191:economics / Q000627:therapeutic use; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006575:Heterocyclic Compounds, 3-Ring / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000191:economics / Q000627:therapeutic use; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D066230:Patient-Specific Modeling; D011759:Pyrrolidines; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D000069616:Simeprevir; D000069474:Sofosbuvir; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use; D014542:Uridine Monophosphate / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives
chemical_list: D000998:Antiviral Agents; D001562:Benzimidazoles; D002219:Carbamates; D005449:Fluorenes; D006575:Heterocyclic Compounds, 3-Ring; D007093:Imidazoles; D016898:Interferon-alpha; D011759:Pyrrolidines; D013449:Sulfonamides; C000595958:ledipasvir, sofosbuvir drug combination; D012254:Ribavirin; D000069616:Simeprevir; D014542:Uridine Monophosphate; D014633:Valine; C549273:daclatasvir; D000069474:Sofosbuvir