Abstract
Background: Hepatitis C virus (HCV) genotype 1 is the most prevalent HCV infection in China. Sofosbuvir-based direct antiviral agent (DAA) regimens are the current mainstays of treatment. Sofosbuvir/velpatasvir (SOF/VEL) and sofosbuvir/ledipasvir (SOF/LDV) regimens became reimbursable in China in 2020. Thus, this study aimed to identify the optimal SOF-based regimen and to inform efficient use of healthcare resources by optimizing DAA use in treating HCV genotype 1.Methods and Models: A modeling-based cost-utility analysis was conducted from the payer's perspective targeting adult Chinese patients with chronic HCV genotype 1 infection. Direct medical costs and health utilities were inputted into a Markov model to simulate lifetime experiences of chronically infected HCV patients after receiving SOF/LDV, SOF/VEL or the traditional strategy of pegylated interferon (pegIFN) + ribavirin (RBV). Discounted lifetime cost and quality adjusted life years (QALYs) were computed and compared to generate the incremental cost utility ratio (ICUR). An ICUR below the threshold of 31,500 $/QALY suggests cost-effectiveness. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of model findings.Results: Both SOF/LDV and SOF/VEL regimens were dominant to the pegIFN + RBV regimen by creating more QALYs and incurring less cost. SOF/LDV produced 0.542 more QALYs but cost $10,390 less than pegIFN + RBV. Relative to SOF/LDV, SOF/VEL had an ICUR of 168,239 $/QALY which did not meet the cost-effectiveness standard. Therefore SOF/LDV was the optimal strategy. These findings were robust to linear and random variations of model parameters. However, reducing the SOF/VEL price by 40% would make this regimen the most cost-effective option.Conclusions: SOF/LDV was found to be the most cost-effective treatment, and SOF/VEL was also economically dominant to pegIFN + RBV. These findings indicated that replacing pegIFN + RBV with DAA regimens could be a promising strategy.
Highlights
Hepatitis C virus (HCV) infection is an escalating global health concern
direct acting antiviral agents (DAAs) are highly effective in treating HCV as sustained virologic response (SVR) rates of these drugs are generally higher than 95% [7]
As projected by our model (Table 3), pegIFN + RBV was dominated by both SOF/LDV and SOF/VEL regimens by creating more quality-adjusted life years (QALYs) and incurring less cost
Summary
Hepatitis C virus (HCV) infection is an escalating global health concern. China alone has contributed 10 million cases of chronic HCV (CHC) infection accounting for 7% of global infections [1]. Within the current healthcare system, HCV epidemic and resulting complications such as cirrhosis, decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC) and liver transplantation (LT) are expected to increase in the 10 years [5]. This presents a significant public health challenge to the Chinese government and subsequently to the WHO goal of global HCV elimination by 2030 [6]. Sofosbuvir (SOF)based regimens appear to be the most widely used treatment strategy largely because sofosbuvir/velpatasvir (SOF/VEL) was the first and only DAA included in the National Essential Drug List (October 2018) in China [9]. This study aimed to identify the optimal SOF-based regimen and to inform efficient use of healthcare resources by optimizing DAA use in treating HCV genotype 1
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