title: Cost-effectiveness analysis of sofosbuvir compared to current standard treatment in Swiss patients with chronic hepatitis C.
abstract: In clinical trials, sofosbuvir showed high antiviral activity in patients infected with hepatitis C virus (HCV) across all genotypes. We aimed to determine the cost-effectiveness of sofosbuvir-based treatment compared to current standard treatment in mono-infected patients with chronic hepatitis C (CHC) genotypes 1-4 in Switzerland. Cost-effectiveness was modelled from the perspective of the Swiss health care system using a lifetime Markov model. Incremental cost-effectiveness ratios (ICERs) used an endpoint of cost per quality-adjusted life year (QALY) gained. Treatment characteristics, quality of life, and transition probabilities were obtained from published literature. Country-specific model inputs such as patient characteristics, mortality and costs were obtained from Swiss sources. We performed extensive sensitivity analyses. Costs and effects were discounted at 3% (range: 0-5%) per year. Sofosbuvir-containing treatment in mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 showed ICERs between CHF 10,337 and CHF 91,570 per QALY gained. In subgroup analyses, sofosbuvir dominated telaprevir- and boceprevir-containing treatment in treatment-naïve genotype 1 cirrhotic patients. ICERs of sofosbuvir were above CHF 100,000 per QALY in treatment-naïve, interferon eligible, non-cirrhotic patients infected with genotypes 2 or 3. In deterministic and probabilistic sensitivity analyses, results were generally robust. From a Swiss health care system perspective, treatment of mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 with sofosbuvir-containing treatment versus standard treatment would be cost-effective if a threshold of CHF 100,000 per QALY was assumed.
authors.affiliation: Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
authors.forename: Alena M
authors.initials: AM
authors.lastname: Pfeil
authors.affiliation: Department of Health Sciences, Helsana Group, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.affiliation: OPTUMInsight, Uxbridge, Middlesex, United Kingdom.
authors.forename: Ines M
authors.initials: IM
authors.lastname: Guerra
authors.affiliation: OPTUMInsight, Uxbridge, Middlesex, United Kingdom.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Cure
authors.affiliation: Divisions of Gastroenterology and Hepatology and of Clinical Pathology, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Negro
authors.affiliation: Swiss HPB (Hepato-Pancreato-Biliary) Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.affiliation: World Health Organization (WHO), African Union, Governments, Denges VD, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lavanchy
authors.affiliation: Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwenkglenks
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D008390:Markov Chains; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D000069474:Sofosbuvir / Q000191:economics* / Q000627:therapeutic use; D013557:Switzerland / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D000069474:Sofosbuvir