Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India

Abstract

Background & aimsAvailability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective.MethodsA previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs. Model parameters were estimated from published studies. Cost-effectiveness of HCV treatment using available DAAs was calculated, using a payer’s perspective. We estimated quality-adjusted life years (QALYs), disability-adjusted life years (DALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted.ResultsCompared with no treatment, the use of generic DAAs in Indian HCV patients would increase the life expectancy by 8.02 years, increase QALYs by 3.89, avert 19.07 DALYs, and reduce the lifetime healthcare costs by $1,309 per-person treated. Treatment became cost-effective within 2 years, and cost-saving within 10 years of its initiation overall and within 5 years in persons with cirrhosis. Treating 10,000 HCV-infected persons could prevent 3400–3850 decompensated cirrhosis, 1800–2500 HCC, and 4000–4550 liver-related deaths. The results were sensitive to the costs of DAAs, pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response.ConclusionsTreatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective.

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

“…A modelling study showed that treatment of HCV infection using generic direct-acting antiviral drugs is cost-saving. 402 Provision of HBV oral drugs through the National Viral Hepatitis Control Program is currently in the planning stage.…”

The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes

“…Despite these high costs, DAA treatment in the majority of patients has been found to be generally cost effective, with some regimens characterized as cost saving in the non-transplant population. 33,34 While early treatment regimens, such as those identified in this data set, were very expensive, competition from newly released agents has dramatically reduced the cost of treatment in an effort to increase market share. Treatment costs have also been reduced after shorter durations of care and have been demonstrated to be equally effective.…”

Hepatitis C: Is eradication possible?

“…Regimens based upon these drugs have been shown not only to be safe and efficacious, but even cost-effective within 2 years, and cost-saving within 10 years of their initiation overall and within 5 years in persons with cirrhosis. 58 Pan-genotypic drugs will contribute to further reduce costs for HCV cure.…”