Cost-Effectiveness Analysis of Direct-Acting Antiviral Agents for Occupational Hepatitis C Infections in Germany

Abstract

Around 1% of the world’s population is infected with hepatitis C. The introduction of new direct-acting antiviral agents (DAAs) in 2014 has substantially improved hepatitis C treatment outcomes. Our objective was to evaluate the long-term cost effectiveness of DAAs in health care personnel (HP) with confirmed occupational diseases in Germany. A standardised database from a German statutory accident insurance was used to analyse the cost-effectiveness ratio for the DAA regimen in comparison with interferon-based triple therapies. Taking account of the clinical progression of the disease, a Markov model was applied to perform a base case analysis for a period of 20 years. The robustness of the results was determined using a univariate deterministic sensitivity analysis. The results show that treatment with DAAs is more expensive, but also more effective than triple therapies. The model also revealed that the loss of 3.23 life years can be averted per patient over the 20 years. Compared to triple therapies, DAA treatment leads to a higher sustained virologic response (SVR). Although this results in a decrease of costs in the long term, e.g., pension payments, DAA therapy will cause greater expense in the future due to the high costs of the drugs.

Hepatitis C in healthcare personnel: follow-up analysis of treatments with direct-acting antiviral agents

“…This effect becomes more pronounced the earlier an HCV infection is diagnosed and treated. Taking pension benefits into account, use of DAA treatments in insured HP without cirrhosis correlates with a reduction in costs [5]. Costeffectiveness models also show that early treatment is more cost-efficient than treatment at a later stage of the disease [15].…”

“…This regimen achieves highly sustained virological responses (SVRs) of over 95% with high compatibility [1]. Although DAA regimens are more effective, they are more costly than interferon-based treatments due to the expensive drugs involved [5]. Healthcare personnel (HP) work in environments with specific accident and disease risks.…”