The value of cure associated with treating treatment-naïve chronic hepatitis C genotype 1: Are the new all-oral regimens good value to society?
All-oral regimens are associated with high cure rates in hepatitis C virus-genotype 1 (HCV-GT1) patients. Our aim was to assess the value of cure to the society for treating HCV infection.



Markov model for HCV-GT1 projected long-term health outcomes, life years, and quality-adjusted life years (QALYs) gained. The model compared second-generation triple (sofosbuvir+pegylated interferon+ribavirin [PR] and simeprevir+PR) and all-oral (ledipasvir/sofosbuvir and ombitasvir+paritaprevir/ritonavir+dasabuvir±ribavirin) therapies with no treatment. Sustained virological response rates were based on Phase III RCTs. We assumed that 80% and 95% of HCV-GT1 patients were eligible for second-generation triple and all-oral regimens. Transition probabilities, utility and mortality were based on literature review. The value of cure was calculated by the difference in the savings from the economic gains associated with additional QALYs.



Model estimated 1.52 million treatment-naïve HCV-GT1 patients in the US. Treating all eligible HCV-GT1 patients with second-generation triple and all-oral therapies resulted in 3.2 million and 4.8 million additional QALYs gained compared to no treatment respectively. Using $50,000 as value of QALY, these regimens lead to savings of $185 billion and $299 billion; costs of these regimens were $109 billion and $128 billion. The value of cure with second-generation triple and all-oral regimens was $55 billion and $111 billion, when we conservatively assumed only drug costs. Cost savings were greater for HCV-GT1 patient cured with cirrhosis compared to patients without cirrhosis.



The recent evolution of regimens for HCV GT1 has increased efficacy and value of cure.
Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
Zobair M
ZM
Younossi
University of Florida, Gainesville, FL, USA.
Haesuk
H
Park
Mount Sinai Medical Center, New York City, NY, USA.
Douglas
D
Dieterich
University of California Los Angeles, Los Angeles, CA, USA.
Sammy
S
Saab
Stanford University, Stanford, CA, USA.
Aijaz
A
Ahmed
Henry Ford Hospital, Detroit, MI, USA.
Stuart C
SC
Gordon
D000284:Administration, Oral; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001562:Benzimidazoles / Q000008:administration & dosage; D003657:Decision Making; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000191:economics; D005449:Fluorenes / Q000008:administration & dosage; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000821:virology; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000008:administration & dosage; D000069616:Simeprevir / Q000008:administration & dosage; D000069474:Sofosbuvir / Q000008:administration & dosage; D000072230:Sustained Virologic Response; D014481:United States; D014542:Uridine Monophosphate / Q000008:administration & dosage / Q000031:analogs & derivatives
D000998:Antiviral Agents; D001562:Benzimidazoles; D005449:Fluorenes; C000595958:ledipasvir, sofosbuvir drug combination; D012254:Ribavirin; D000069616:Simeprevir; D014542:Uridine Monophosphate; D000069474:Sofosbuvir
HCV treatment; Markov model; all-oral regimens; economic analysis; hepatitis C; hepatitis C virus; value of cure