Abstract
BackgroundHepatitis C is the second fastest growing infectious disease in China. The standard-of-care for chronic hepatitis C in China is Pegylated interferon plus ribavirin (PR), which is associated with tolerability and efficacy issues. An interferon- and ribavirin-free, all-oral regimen comprising daclatasvir (DCV) and asunaprevir (ASV), which displays higher efficacy and tolerability, has recently been approved in China.ObjectivesThis study is to estimate the cost-effectiveness of DCV+ASV (24 weeks) for chronic hepatitis C genotype 1b treatment-naïve patients compared with PR regimen (48 weeks) in China.MethodsA cohort-based Markov model was developed from Chinese payer perspective to project the lifetime outcomes of treating 10,000 patients with an average age of 44.5 with two hypothetical regimens, DCV+ASV and PR. Chinese-specific health state costs and efficacy data were used. The annual discount rate was 5%. Base-case analysis and sensitivity analysis were conducted.ResultsFor HCV Genotype 1b treatment-naïve patients, DCV+ASV proved to be dominant over PR, with a cost saving of ¥33,480(5,096 USD) and gains in QALYs and life years of 1.29 and 0.85, respectively. The lifetime risk of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver-related death was greatly reduced with DCV+ASV. Univariate sensitivity analysis demonstrated that key influencers were the discount rate, time horizon, initial disease severity and sustained virological response rate of DCV+ASV, with all scenarios resulting in additional benefit. Probabilistic sensitivity analysis demonstrated that DCV+ASV has a high likelihood (100%) of being cost-effective.ConclusionDCV+ASV is not only an effective and well-tolerated regimen to treat chronic HCV genotype 1b infection treatment-naïve patients, but also is more cost-effective than PR regimen. DCV+ASV can benefit both the public health and reimbursement system in China.
Highlights
Hepatitis C is a liver disease caused by hepatitis C virus which is mainly transmitted by blood
For HCV Genotype 1b treatment-naïve patients, DCV+ASV proved to be dominant over plus ribavirin (PR), with a cost saving of ¥33,480(5,096 USD) and gains in quality-adjusted life years (QALYs) and life years of 1.29 and 0.85, respectively
The lifetime risk of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver-related death was greatly reduced with DCV+ASV
Summary
Hepatitis C is a liver disease caused by hepatitis C virus which is mainly transmitted by blood. In China, recent epidemiological studies suggest that the reporting incidence of HCV infection has risen from 0.7 to 15.0 cases per 100,000 persons over the last decade [3]. The estimated age-standardized rates of HCC incidence cases in China is 22.3 per 100,000 persons [5]. While chronic HBV remains the dominant cause of liver disease in China [6], HCV currently accounts for a relatively small but increasing proportion of HCC [7], with age-standardized death rates increasing 1.5 per 100,000 population from 1990 to 2010 [8]. The standard-of-care for chronic hepatitis C in China is Pegylated interferon plus ribavirin (PR), which is associated with tolerability and efficacy issues. An interferon- and ribavirin-free, all-oral regimen comprising daclatasvir (DCV) and asunaprevir (ASV), which displays higher efficacy and tolerability, has recently been approved in China
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