title: Cost-effectiveness and budget impact of interferon-free direct-acting antiviral-based regimens for hepatitis C treatment: the French case.
abstract: We evaluated the cost-effectiveness and the budget impact of new DAA-based regimen use in France. A Markov model simulated chronic hepatitis C (CHC) treatment interventions with IFN-based and IFN-free regimens at stage of fibrosis ≥F3, ≥F2 or regardless of fibrosis stage, and treatment either with the least or the most expensive combination. It estimated quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). It also assessed the budget impact over 5 years of treating all CHC-screened patients, regardless of fibrosis, assuming ≤20 000 patients treated/year and priority to ≥F3. Sensitivity analyses were also conducted. For genotypes (G) 1-4, the initiation of IFN-free regardless of fibrosis was a cost-effective strategy compared to prior standard of care (SOC) initiated at stage F2: €40 400-88 300/QALY gained in G1; similar results were obtained for patients infected with G4. Considering G2-3, the most cost-effective strategy was IFN-based regimens regardless of fibrosis compared to prior SOC initiated at stage F2: €21 300 and €19 400/QALY gained, respectively; the strategy with IFN-free regimens being more effective but not cost-effective at current costs. The budget impact of treating all CHC-screened patients over 5 years would range between 3.5 and 7.2 billion €, depending on whether one considers the least or the most expensive combination of new DAAs and whether one treats G2-3 with IFN-based or IFN-free new DAAs. In France, treatment initiation with new DDAs regardless of fibrosis stage is cost-effective, but would add 3.5-7.2 billion € to an already overburdened medical care system.
authors.affiliation: Inserm, IAME, UMR 1137, Paris, France. sylvie.burban@yahoo.fr.|Univ Paris Diderot, Sorbonne Paris Cité, Paris, France. sylvie.burban@yahoo.fr.|Univ Lille Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International, Lille, France. sylvie.burban@yahoo.fr.
authors.forename: S
authors.initials: S
authors.lastname: Deuffic-Burban
authors.affiliation: Inserm, IAME, UMR 1137, Paris, France.|Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Obach
authors.affiliation: Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHU Lille, Lille, France.
authors.forename: V
authors.initials: V
authors.lastname: Canva
authors.affiliation: Unité d'hépatologie, Groupe Hospitalier Cochin Hôtel-Dieu, Paris, France.|Inserm U1016, Univ Paris Descartes, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Pol
authors.affiliation: Service Santé Publique, Hôpital Henri Mondor, Créteil, France.
authors.forename: F
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.affiliation: Inserm U955, Hôpital Henri Mondor, Créteil, France.
authors.forename: D
authors.initials: D
authors.lastname: Dhumeaux
authors.affiliation: Univ Lille Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International, Lille, France.|Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHU Lille, Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Mathurin
authors.affiliation: Inserm, IAME, UMR 1137, Paris, France.|Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.|Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Yazdanpanah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors
keywords: budget impact analysis; chronic hepatitis C; cohort Markov model; cost-effectiveness analysis; interferon-free direct-acting antiviral agents