Abstract
Background & aims Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective. Methods A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs. Model parameters were estimated from published studies. Cost-effectiveness of HCV treatment using available DAAs was calculated, using a payer’s perspective. We estimated quality-adjusted life years (QALYs), disability-adjusted life years (DALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted. Results Compared with no treatment, the use of generic DAAs in Indian HCV patients would increase the life expectancy by 8.02 years, increase QALYs by 3.89, avert 19.07 DALYs, and reduce the lifetime healthcare costs by $1,309 per-person treated. Treatment became cost-effective within 2 years, and cost-saving within 10 years of its initiation overall and within 5 years in persons with cirrhosis. Treating 10,000 HCV-infected persons could prevent 3400–3850 decompensated cirrhosis, 1800–2500 HCC, and 4000–4550 liver-related deaths. The results were sensitive to the costs of DAAs, pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response. Conclusions Treatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective.
Highlights
Hepatitis C virus (HCV) infects more than 70 million people worldwide and between 6–11 million in India [1]
The results were sensitive to the costs of directly-acting antivirals (DAAs), pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response
Treatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be cost-saving. In this and similar settings, hepatitis C virus (HCV) treatment should be a priority from a public health as well an economic perspective
Summary
Hepatitis C virus (HCV) infects more than 70 million people worldwide and between 6–11 million in India [1]. New directly-acting antivirals (DAAs) for HCV treatment are highly effective, with DAAbased regimens providing rates of sustained virological response (SVR) exceeding 95%. These regimens are very safe and convenient, needing administration of oral drugs once or twice daily for 12–24 weeks [4]. These drugs offer a hope of reducing the burden of HCV. Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective
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