AV1 - Cost-Effectiveness of Staged Direct-Acting Antiviral Treatment Policies in an Integrated Healthcare System

Abstract

To assess the cost-effectiveness of fibrosis-based direct-acting antiviral (DAA) treatment policies for chronic Hepatitis C (HCV) patients at the Kaiser Permanente Mid-Atlantic States health system (KPMAS). We used a Markov model to compare the lifetime costs and effects of treating chronic HCV patients at different stages of disease severity based on a fibrosis score. The initial distribution of patients across fibrosis scores, the effectiveness of DAA therapy and follow-up and monitoring protocols used to build the model were specific to the KPMAS system. Other parameters, including direct and indirect costs, transition probabilities and health state utilities were derived from the literature. We performed both deterministic and probabilistic sensitivity analyses to assess the robustness of our results. The universal, or 'Treat All', treatment option was the dominant strategy from both the societal and health care sector perspectives. Varying the model parameters in a deterministic analysis did not change this conclusion. It is important to note that the range of incremental costs between the three less restrictive policies was very small – the difference between the ‘Treat F1+’ and the ‘Treat All’ option was just under $100 per person. Probabilistic sensitivity analyses showed, at both the $100,000/QALY and $150,000/QALY thresholds, there was a 70% chance that the ‘Treat All’ option was cost-effective and a 30% chance the ‘Treat F1+’ option was cost-effective. Our results are consistent with the current literature on the value of treating patients with the new DAA therapies – expanded treatment access is cost-effective and in many cases cost saving. While our results are primarily applicable to a unique integrated health care system, the results offer some direction to any health care setting that is faced with resource constraints in the face of these highly priced drugs.