PIN40 COST-EFFECTIVENESS OF DIRECT-ACTING ANTIVIRALS FOR THE TREATMENT OF HEPATITIS C VIRUS IN RUSSIA

Abstract

According to the recently approved rules in Russia, new treatment could enter the reimbursement list only if ICER for it is lower than for the previously included drugs for the same clinical situation. Our objective was to assess cost effectiveness of direct-acting antivirals (DAA) in comparison with historically used combination of pegylated interferon with ribavirin (PR) for HCV genotype 1 in treatment-naïve and treatment-experienced patients to set the willingness-to-pay threshold for this condition. We estimated lifetime costs and outcomes in previously developed model for the treatment-naïve and treatment-experienced patients with HCV genotype1 with and without cirrhosis. The rates of sustained virological response and transition probabilities for disease progression were based on the published data of the international studies. Costs of DAA and PR therapy were assessed using the tariffs for the HCV antiviral treatment in the Russian public health insurance system. Costs of liver disease progression events were derived from the published Russian research. Costs and outcomes were discounted at 5%. All costs were converted into EURO using the average-weighted exchange rate for 2018. The lowest ICER was for treatment-experienced patients with cirrhosis – 226 EURO per life year gained, for patients without cirrhosis - 247 EURO. For treatment-naïve patients ICER was higher: 462 EURO per life year gained for patients with cirrhosis and 1,250 EURO per life year gained in the absence of cirrhosis. DAA is highly cost-effective option for the treatment of HCV genotype 1 in comparison with PR, thus setting in Russia a difficult to pass willingness-to pay threshold for any new treatment for this condition.