Abstract
ObjectiveVery few cost-utility analyses have either evaluated direct-acting antivirals (DAAs) on hepatitis C virus (HCV) genotype 6 patients or undertaken societal perspective. Recently, DAAs have been introduced into the Vietnamese health insurance drug list for chronic hepatitis C (CHC) treatment without empirical cost-effectiveness evidence. This study was conducted to generate these data on DAAs among CHC patients with genotypes 1 and 6 in Vietnam.MethodsA hybrid decision-tree and Markov model was employed to compare costs and quality-adjusted life-years (QALYs) of available DAAs, including (1) sofosbuvir/ledipasvir, (2) sofosbuvir/velpatasvir, and (3) sofosbuvir plus daclatasvir, with pegylated-interferon plus ribavirin (PR). Primary data collection was conducted in Vietnam to identify costs and utility values. Incremental cost-effectiveness ratios were estimated from societal and payer perspectives. Uncertainty and scenario analyses and value of information analyses were performed.ResultsAll DAAs were cost-saving as compared with PR in CHC patients with genotypes 1 and 6 in Vietnam, and sofosbuvir/velpatasvir was the most cost-saving regimen, from both societal and payer perspectives. From the societal perspective, DAAs were associated with the increment of quality-adjusted life-years by 1.33 to 1.35 and decrement of costs by $6519 to $7246. Uncertainty and scenario analyses confirmed the robustness of base-case results, whereas the value of information analyses suggested the need for further research on relative treatment efficacies among DAA regimens.ConclusionsAllocating resources for DAA treatment for HCV genotype 1 and 6 is surely a rewarding public health investment in Vietnam. It is recommended that the government rapidly scale up treatment and enable financial accessibility for HCV patients.
Highlights
In Vietnam, an estimated 1%-2% of the total population is infected with hepatitis C virus (HCV)[1,2,3,4,5] and there are 6 new HCV infections per 100 000 persons annually.[6]
Our results may be useful for countries with a high prevalence of HCV genotype 6, such as Laos (95.6%), Cambodia (56.0%), Myanmar (49.0%), and Thailand (21.8%).[12]
This study has demonstrated that all 3 direct-acting antivirals (DAAs) regimens in the Vietnamese health insurance drug list are cost-saving in HCV patients with genotypes 1 and 6 from both societal and payer perspectives; allocating resources for DAA treatment is surely a rewarding public health investment
Summary
In Vietnam, an estimated 1%-2% of the total population is infected with hepatitis C virus (HCV)[1,2,3,4,5] and there are 6 new HCV infections per 100 000 persons annually.[6]. Since 2019, the Ministry of Health has implemented a new health insurance drug list, where direct-acting antiviral (DAA) regimens have been introduced for the first time. Three regimens were included: (1) sofosbuvir/ledipasvir (SOF/LDV), (2) sofosbuvir/ velpatasvir (SOF/VEL), and (3) sofosbuvir plus daclatasvir (SOF1DCV), while retaining the old standard of HCV treatment, pegylated-interferon plus ribavirin (PR).[14] there has been no empirical evidence on the cost-effectiveness of the newly included DAA regimens in the Vietnamese population. The costeffective evidence generated by this study may inform policy makers in revising the drug list in the coming years and revising the HCV treatment guidelines.
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