A clinician's guide to the cost and health benefits of hepatitis C cure assessed from the individual patient perspective.
OBJECTIVE
The hepatitis C virus (HCV) remains a considerable public health challenge. Novel direct-acting antiviral (DAA) regimens offer high cure rates and the promise of reduced HCV incidence and prevalence following the up-scaling of treatment. This has focused attention towards affordability. This study aimed to estimate the economic value of cure to evaluate the treatment costs justifiable from the patient perspective.


METHODS
A published, validated HCV model was utilized to contrast clinical and cost outcomes for patients aged 30-70 years, stratified by METAVIR F0-F4, for (i) no treatment and (ii) successful treatment [i.e. sustained virologic response (SVR)] ignoring the cost of treatment. Regression equations were fitted and used to determine the financial expenditure justifiable to achieve a cost-neutral or a cost-effective [£20 000 per quality-adjusted life-year (QALY)] cure. Model inputs were derived from UK literature; costs and utilities were discounted at 3.5% over a lifetime horizon.


RESULTS
To achieve cost-neutrality, the maximum discounted expenditure justifiable for SVR was £3774-43 607 across ages and fibrosis stages. Spending between £19 745 (70 years, F0) and £188 420 (30 years, F4) on SVR is expected to be cost-effective at £20 000/QALY willingness-to-pay threshold.


CONCLUSIONS
Heterogeneity across HCV patients is considerable, which can obscure the relevance of conventional cohort-based economic models evaluated at the mean, particularly when considering the value of treatment at the individual patient level. By quantifying the full exposition of HCV cost-savings and health benefits realizable following HCV cure, this study provides insight into the economic value of successful treatment from the patient perspective.
aHealth Economics and Outcomes Research Ltd, Cardiff bSchool of Human and Health Sciences, Swansea University, Swansea cDepartment of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London dUK Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK eWorld Wide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, New Jersey, USA fDepartment of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
Phil
P
McEwan
Nowlan
N
Selvapatt
Ashley
A
Brown
Mark
M
Thursz
Hayley
H
Bennett
Samantha
S
Webster
Anupama
A
Kalsekar
Yong
Y
Yuan
Michael
M
Brenner
Jason
J
Gordon
D000328:Adult; D000367:Age Factors; D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000209:etiology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005102:Health Expenditures; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D008103:Liver Cirrhosis / Q000191:economics / Q000209:etiology / Q000628:therapy*; D008113:Liver Neoplasms / Q000191:economics / Q000209:etiology / Q000628:therapy*; D016031:Liver Transplantation / Q000191:economics; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D013222:State Medicine; D000072230:Sustained Virologic Response; D006113:United Kingdom
D000998:Antiviral Agents