title: The cost-effectiveness, health benefits, and financial costs of new antiviral treatments for hepatitis C virus.
abstract: BACKGROUND
  New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications, increasing demand for treatment and healthcare costs. The cost-effectiveness of new treatments is unknown.
  
  
  METHODS
  We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the US population aged 20 and older to estimate cases identified, treated, sustained viral response, deaths, medical costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective.
  
  
  RESULTS
  Compared to treatment with pegylated interferon and ribavirin (PR), and a protease inhibitor for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555 226, reduced deaths by 80 682, and increased costs by $26.2 billion at an ICER of $47 304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1 110 451 and reduced deaths by an additional 164 540 at an incremental cost of $80.1 billion and an ICER of $72 169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24 921 and $25 405 per QALY gained as compared to PRS/SR.
  
  
  CONCLUSIONS
  New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing.
authors.affiliation: Public Health Department, NORC at the University of Chicago, and.
authors.forename: David B
authors.initials: DB
authors.lastname: Rein
authors.affiliation: Public Health Department, NORC at the University of Chicago, and.
authors.forename: John S
authors.initials: JS
authors.lastname: Wittenborn
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: Public Health Department, NORC at the University of Chicago, and.
authors.forename: Danielle K
authors.initials: DK
authors.lastname: Liffmann
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: John W
authors.initials: JW
authors.lastname: Ward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000627:therapeutic use; D000069616:Simeprevir / Q000627:therapeutic use; D000069474:Sofosbuvir; D014481:United States; D014542:Uridine Monophosphate / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin; D000069616:Simeprevir; D014542:Uridine Monophosphate; D000069474:Sofosbuvir
keywords: antiviral treatment; cost-effectivenes; hepatitis C; pharmacoeconomics; public health