title: Cost-effectiveness of sofosbuvir for the treatment of chronic hepatitis C-infected patients.
abstract: The efficacy of treatment for hepatitis C genotype 1 infection has significantly improved with the introduction of first-generation protease inhibitors. However, there remains a need for effective treatments for patients infected with other genotypes, for nonresponders and patients unsuitable for interferon. Sofosbuvir is the first nucleotide polymerase inhibitor with pan-genotypic activity. Sofosbuvir-based regimens have resulted in >90% sustained virological response across treatment-naïve genotype 1-6 patients in five phase III clinical trials of sofosbuvir administered with ribavirin or pegylated interferon and ribavirin. This analysis evaluates the cost-effectiveness of sofosbuvir within the current licensed indication, for genotype 1-6 in the UK. A Markov model followed a cohort of 10 000 patients over lifetime, with approximately 20% initiating treatment for compensated cirrhosis. Sofosbuvir-regimens were compared to telaprevir, boceprevir, pegylated interferon and ribavirin, or no treatment. Costs and outcomes were discounted at 3.5%. The cost perspective utilized costs applicable to the National Health Service in the UK. Sofosbuvir proved to be cost-effective in most patient populations with incremental cost-effectiveness ratios (ICERs) at £11 836/QALY and £7292/QALY against telaprevir and boceprevir, respectively. In genotype 3, sofosbuvir had a weighted ICER of £18 761/QALY. Sofosbuvir-based regimens are a cost-effective option for the majority of hepatitis C-infected patients in the United Kingdom although the incremental cost-effectiveness varies by genotype and regimen. Sofosbuvir and ribavirin is an alternative regimen for patients unsuitable for interferon.
authors.affiliation: Mapi, Uxbridge, UK.
authors.forename: S
authors.initials: S
authors.lastname: Cure
authors.affiliation: Mapi, Uxbridge, UK.
authors.forename: I
authors.initials: I
authors.lastname: Guerra
authors.affiliation: UCL Division of Liver and Digestive Health Royal Free Hospital, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Dusheiko
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000069474:Sofosbuvir / Q000008:administration & dosage* / Q000191:economics*; D006113:United Kingdom
chemical_list: D000998:Antiviral Agents; D000069474:Sofosbuvir
keywords: chronic hepatitis C infection; cost-effectiveness analysis; sofosbuvir