PIN19 - Cost-Effectiveness of Elbasvir/Grazoprevir Versus Ombitasvir/Paritaprevir/Ritonavir Plus Dasabuvir (3D Regimen) for Treatment of Chronic Hepatitis C Genotype 1B Patients in China

Abstract

The quantity of HCV-positive patients is estimated to be 10 million in China, 56.8% of which were infected with HCV genotype 1b. New direct-acting antivirals (DAAs) showed extremely high efficacy and safety, but little is known on the cost-effectiveness between them in Chinese populations. We aimed to compare the cost-effectiveness of elbasvir/grazoprevir(EBR/GZR) with ombitasvir/paritaprevir/ritonavir plus dasabuvir(3D regimen) in Chinese chronic hepatitis C patients with genotype 1b infection. The chronic HCV disease progression in patients with or without cirrhosis was simulated using the Markov cohort state-transition models. Patient age was set as 45 years with the initiation of treatment according to epidemiologic profile in China. Clinical trial data in testing the efficacy of the two regimens from literature and official documents were analyzed. Resource use, unit cost, economic inputs and state-utility were collected or estimated from published sources based on Chinese populations. The lifetime outcomes/cost and incremental cost-effectiveness ratio (ICER) were calculated. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results. EBR/GZR had higher QALYs and lower costs for noncirrhotic HCV patients as compared to the 3D regimen (13.8675 QALYs, 82,090.82 RMB vs 13.8200 QALYs, 82,281.55 RMB). In cirrhotic patients, EBR/GZR had higher QALY and higher cost (12.8416 QALYs, 225,807.70 RMB vs 12.8238 QALYs, 224,895.70 RMB) than 3D. EBR/GZR regimen in cirrhotic HCV 1b patients had an ICER of 51,373.26 RMB per QALY gained, lower than the threshold for cost-effective treatment of HCV in China (160,000 RMB, 3 times per capita GDP). The probability of acceptance of EBR/GZR increased from 48.3% to 64.4% in noncirrhotic patients and from 47.3% to 54.7% in cirrhotic patients when the willingness-to-pay increased from 0 to 160,000 RMB. EBR/GZR was economically dominant in patients without cirrhosis and was cost-effective in cirrhotic patients in comparison with 3D for HCV 1b treatment.