PIN47 - Cost-Effectiveness Analysis of Daclatasvir in Combination with Asunaprevir (DUAL) for the Treatment of Chronic Hepatitis C Patients in China

Abstract

The study aims to evaluate the cost-effectiveness of standard of care (SOC), Daclatasvir in combination with Asunaprevir therapy and other direct acting antiviral agent regimens for the treatment of chronic hepatitis c patients in China. A Markov model was performed based on a payer perspective to estimate costs and quality-adjusted life years (QALYs) between interferon-alfa + ribavirin (IFN+RBV), pegylated interferon-alfa-2a + ribavirin (PegIFN+RBV), DUAL and Sofosbuvir/Ledipasvir (SOF/LDV) for HCV patients in China. Six health states were set according to natural history, including healed, chronic hepatitis C, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death. Health-state transition probabilities, sustained virological responses, and utility values were retrieved from Chinese-specific clinical trials and published literature. Treatment and disease management costs, life expectancy, quality-adjusted life years (QALYs) and cost-effectiveness were measured. Direct medical costs were included and obtained from published articles and Chinese standard cost list. The incremental cost-effectiveness ratio (ICER) was presented as costs per QALY gained. All costs, life years and QALYs were discounted by 3.5% per year. In treatment-naïve patients, DUAL drug costs was USD8,353 (RMB54,293), higher than IFN+RBV(USD1,403) and PegIFN+RBV regimen(USD6,890), but lower than SOF/LDV(USD44,524). DUAL was associated with 2.71-4.16 QALYs gained and 0.83-1.32 incremental life-years per patient versus SOC, with discounted lifetime cost savings of USD7,393-7,491 per patient. For interferon-ineligible/intolerant patients, DUAL drug costs was USD8,368, lower than SOF/LDV. DUAL disease management costs was USD4,396, lower than IFN+RBV(USD18,740) and PegIFN+RBV regimen(USD13,350), higher than SOF/LDV(USD2,360). Results were robust across univariate and probabilistic sensitivity analyses. It is demonstrated that treatment with DUAL provides significant clinical benefit, whilst accruing lower lifetime costs, due to improved rates of sustained virologic response over SOC.