Cost-Effectiveness of Genotype 1 Chronic Hepatitis C Virus Treatments in Patients Coinfected with Human Immunodeficiency Virus in the United States.

Abstract

New treatments for chronic hepatitis C virus (HCV) are highly effective in patients coinfected with human immunodeficiency virus (HIV). This study estimated the cost-effectiveness of treatments for genotype 1 (GT1) HCV in HIV-coinfected patients. A Markov model based on HCV natural history was used. The base-case analysis included both treatment-naïve and -experienced patients. Alternatives were ombitasvir/paritaprevir/ritonavir, dasabuvir with or without ribavirin (3D±R) for 12 or 24weeks, sofosbuvir plus peginterferon and R (SOF+PR) for 12weeks, SOF+R for 24weeks, and no treatment (NT). A subgroup analysis restricted to treatment-naïve, non-cirrhotic patients compared 3D±R for 12weeks to SOF plus ledipasvir (LDV) for 12weeks and NT. Transition probabilities, utilities, and costs were obtained from the published literature. Outcomes were measured over a lifetime horizon and included rates of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver-related death, total costs, life-years, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). In the base-case, SOF+R was dominated by both SOF+PR and 3D±R. Compared to SOF+PR, 3D±R had an ICER of $45,581. The lifetime rates of liver morbidity and mortality were lower among those treated with 3D±R compared to SOF+PR, SOF+R, or NT. In the subgroup analysis, 3D±R was cost-effective compared to NT at a threshold of $50,000 per QALY (ICER $27,496). SOF/LDV had an ICER of $104,489 per QALY gained compared to 3D±R. In the GT1 HCV population coinfected with HIV, 3D±R was cost-effective compared to NT, SOF+R, and SOF+PR. In the treatment-naïve sub-population, 3D±R was cost-effective compared to NT and SOF/LDV.