title: Drug therapies for chronic hepatitis C infection: a cost-effectiveness analysis.
abstract: BACKGROUND
  Before 2011, pegylated interferon plus ribavirin was the standard therapy for chronic hepatitis C. Interferon-free direct-acting antiviral agents were then approved. Although these treatments appear to be more effective, they are substantially more expensive. In anticipation of the need for information regarding the comparative cost-effectiveness of new regimens in a recent therapeutic review, we conducted the analysis to inform listing decision in Canada.
  
  
  METHODS
  A state-transition model was developed in the form of a cost-utility analysis. Regimens included in the analysis were comprehensive. The cohort under consideration had a mean age of 50 years. The cohort was defined by treatment status and cirrhosis status. Inputs for the model were derived from published sources and validated by clinical experts.
  
  
  RESULTS
  For each genotype 1 population, at least 1 of the interferon-free agents appeared to be economically attractive compared with pegylated interferon-ribavirin, at a willingness-to-pay of $50 000 per quality-adjusted life-year. The drug that was the most cost-effective varied by population. For genotype 2-4 population, the direct-acting antiviral therapies appeared not to be economically attractive compared with pegylated interferon-ribavirin for the treatment-naive; however, there were direct-acting antiviral therapies that appeared to be attractive when compared with no treatment for the treatment-experienced.
  
  
  CONCLUSIONS
  Public health policy should be informed by consideration of health benefit, social and ethical values, feasibility and cost-effectiveness. Our analysis assists the development of reimbursements and policies for interferon-free direct-acting antiviral agent regimens for chronic hepatitis C infection by informing the last criterion. Considering the rapid development of treatments for chronic hepatitis C, further update and expanded reviews will be necessary.
authors.affiliation: School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont.
authors.forename: William W L
authors.initials: WW
authors.lastname: Wong
authors.affiliation: School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Lee
authors.affiliation: School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Singh
authors.affiliation: School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont.
authors.forename: George
authors.initials: G
authors.lastname: Wells
authors.affiliation: School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Jordan J
authors.initials: JJ
authors.lastname: Feld
authors.affiliation: School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn