title: The cost-effectiveness of sofosbuvir-based regimens for treatment of hepatitis C virus genotype 2 or 3 infection.
abstract: BACKGROUND
  Chronic infection with hepatitis C virus (HCV) genotype 2 or 3 can be treated with sofosbuvir without interferon. Because sofosbuvir is costly, its benefits should be compared with the additional resources used.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of sofosbuvir-based treatments for HCV genotype 2 or 3 infection in the United States.
  
  
  METHODS
  Monte Carlo simulation, including deterministic and probabilistic sensitivity analyses.
  
  
  METHODS
  Randomized trials, observational cohorts, and national health care spending surveys.
  
  
  METHODS
  8 patient types defined by HCV genotype (2 vs. 3), treatment history (naive vs. experienced), and cirrhosis status (noncirrhotic vs. cirrhotic).
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Payer.
  
  
  METHODS
  Sofosbuvir-based therapies, pegylated interferon-ribavirin, and no therapy.
  
  
  METHODS
  Discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  The ICER of sofosbuvir-based treatment was less than $100,000 per QALY in cirrhotic patients (genotype 2 or 3 and treatment-naive or treatment-experienced) and in treatment-experienced noncirrhotic patients but was greater than $200,000 per QALY in treatment-naive noncirrhotic patients.
  
  
  RESULTS
  The ICER of sofosbuvir-based therapy for treatment-naive noncirrhotic patients with genotype 2 or 3 infection was less than $100,000 per QALY when the cost of sofosbuvir was reduced by approximately 40% and 60%, respectively. In probabilistic sensitivity analyses, cost-effectiveness conclusions were robust to uncertainty in treatment efficacy.
  
  
  CONCLUSIONS
  The analysis did not consider possible benefits of preventing HCV transmission.
  
  
  CONCLUSIONS
  Sofosbuvir provides good value for money for treatment-experienced patients with HCV genotype 2 or 3 infection and those with cirrhosis. At their current cost, sofosbuvir-based regimens for treatment-naive noncirrhotic patients exceed willingness-to-pay thresholds commonly cited in the United States.
  
  
  BACKGROUND
  National Institute on Drug Abuse and National Institute of Allergy and Infectious Diseases.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Linas
authors.forename: Devra M
authors.initials: DM
authors.lastname: Barter
authors.forename: Jake R
authors.initials: JR
authors.lastname: Morgan
authors.forename: Mai T
authors.initials: MT
authors.lastname: Pho
authors.forename: Jared A
authors.initials: JA
authors.lastname: Leff
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
authors.forename: Sabrina A
authors.initials: SA
authors.lastname: Assoumou
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Arthur Y
authors.initials: AY
authors.lastname: Kim
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000209:etiology; D008390:Markov Chains; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D000069474:Sofosbuvir; D014481:United States; D014542:Uridine Monophosphate / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin; D014542:Uridine Monophosphate; D000069474:Sofosbuvir
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