Estimating the price at which hepatitis C treatment with direct-acting antivirals would be cost-saving in Japan

Yueran Zhuo,Jagpreet Chhatwal,Rakesh Aggarwal,Qiushi Chen,Yvan Hutin,Tomoyuki Hayashi

doi:10.1038/s41598-020-60986-4

Abstract

In Japan, 1.5–2 million people are chronically infected with hepatitis C virus (HCV) infection. New direct-acting antiviral agents (DAA) offer an unprecedented opportunity to cure HCV. While the price of HCV treatment decreased recently in most countries, it remains one of the highest in Japan. Our objective was to evaluate the cost-effectiveness of HCV treatment in patients of different age groups and to estimate the price at which DAAs become cost-saving in Japan. A previously developed microsimulation model was adapted to the Japanese population and updated with Japan-specific health utilities and costs. Our model showed that compared with no treatment, the incremental cost-effectiveness ratio (ICER) of DAAs at a price USD 41,046 per treatment was USD 9,080 per quality-adjusted life year (QALY) gained in 60-year-old patients. HCV treatment became cost-effective after 9 years of starting treatment. However, if the price of DAAs is reduced by 55–85% (USD 6,730 to 17,720), HCV treatment would be cost-saving within a 5 to 20-year time horizon, which should serve to increase the uptake of DAA-based HCV treatment. The payers of health care in Japan could examine ways to procure DAAs at a price where they would be cost-saving.

Highlights

Hepatitis C virus (HCV) infection affects 71 million people globally[1]
The no-treatment strategy had a lifetime cost of U.S dollars (USD) 23,206 per person infected; the directacting antiviral agents (DAA) scenario resulted in higher lifetime cost of USD 47,431 per person infected, with 91% spent on DAA treatment, and smaller amounts on testing (1%) and HCV disease management (8%); resulting in an incremental cost-effectiveness ratio (ICER) of USD 9,080 per quality-adjusted life year (QALY) gained
DAA treatment was more cost-effective in younger patients – ICER was USD 1,998/QALY for age 30 versus USD 24,085 per QALY gained for age 70 (Table 2)

Summary

Introduction

Hepatitis C virus (HCV) infection affects 71 million people globally[1]. If untreated, HCV infection can lead to cirrhosis, hepatocellular carcinoma (HCC) and liver-related death. In 2014, the Japan Ministry of Health, Labor and Welfare approved DAAs for HCV treatment, and the Japan Society of Hepatology guidelines recommended using them for treating HCV infection ever since[6,7]. (i.e., increase QALY but reduce the total cost associated with HCV) in countries such as United States[9] and United Kingdom[10], but none of the published studies has evaluated if and at what price HCV treatment becomes cost-saving in Japan[11,12,13,14,15,16].

Objectives

Methods

Results

Conclusion