Cost-Effectiveness Analysis of Oral Direct-Acting Antivirals for Chinese Patients with Chronic Hepatitis C
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ORIGINAL RESEARCH ARTICLE
Cost‑Effectiveness Analysis of Oral Direct‑Acting Antivirals for Chinese Patients with Chronic Hepatitis C Pingyu Chen1,2 · Min Jin1 · Yang Cao1 · Hongchao Li1,2 Accepted: 29 October 2020 © Springer Nature Switzerland AG 2020
Abstract Background and Objective All oral direct-acting antivirals (DAAs) have shown excellent efficacy and safety in Chinese patients with chronic hepatitis C (CHC). However, the cost of DAAs used to be expensive; therefore, large numbers of patients had no access to DAAs in China. Recently, prices have been greatly reduced. The objective of this study was to evaluate the cost-effectiveness of ledipasvir/sofosbuvir (LDV/SOF), sofosbuvir/velpatasvir (SOF/VEL), elbasvir/grazoprevir (EBR/ GZR) and glecaprevir/pibrentasvir (GLE/PIB) in Chinese CHC patients stratified by hepatitis C virus (HCV) genotype (GT), cirrhosis status, and treatment history. Methods On the basis of a Chinese healthcare perspective, a Markov model was constructed to estimate the lifetime costs and health outcomes of patients treated with different DAA regimens. Chinese-specific clinical, cost, and utility inputs were obtained or calculated from published sources and expert opinions. Costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were reported as primary outcomes. Base-case analysis and sensitivity analysis were conducted. Results At a willing-to-pay (WTP) threshold of US$30,081/QALY (calculated by three times the GDP per capita in China), SOF/VEL was cost-effective in patients with HCV GT 1, 3, and 6 infections, and the probabilities that SOF/VEL was costeffective were 9.7–75.7%, 39.1–63.9%, and 35.6–88.0%, respectively. For GT2 patients, noncirrhotic patients, treatmentnaïve patients, and treatment-experienced patients, LDV/SOF was the most cost-effective regimen, and the probabilities of cost-effectiveness for each of these groups was 92.1–99.8%, 89.9–99.0%, 61.6–91.2%, and 99.3–100.0%, respectively below the WTP threshold. The GLE/PIB regimen (12-week duration) was the most cost-effective in cirrhotic patients, whereas the probability of its cost-effectiveness varied with that of EBR/GZR (4.1–93.8% versus 6.2–93.3%) below the WTP threshold. Conclusions Overall, SOF/VEL and LDV/SOF regimens are more likely to be cost-effective among various subgroups of Chinese patients with CHC.
Co-first authors: Pingyu Chen and Min Jin contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40258-020-00623-3) contains supplementary material, which is available to authorized users. * Hongchao Li [email protected] 1
Department of Health Economics, China Pharmaceutical University, Nanjing, China
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
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Key Points for Decision Makers Ledipasvir/sofosbuvir and sofosbuvir/velpatasvir regimens are more likely to be cost-effec
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