Cost‐effectiveness of the highly effective direct‐acting antivirals in the treatment of chronic hepatitis C in Hong Kong

Lo, Angeline Oi–Shan; Chan, Henry Lik‐Yuen; Wong, Vincent Wai‐Sun; Wong, Grace Lai–Hung

doi:10.1111/jgh.13638

Cited by 6 publications

(5 citation statements)

References 40 publications

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“…The high list price of DAA treatment prohibits the Hong Kong government to set it as the first‐line treatment for HCV due to limitations in fixed healthcare budgets. Yet our previous cost‐effectiveness analysis showed that even with the current local price ranging from US$30 000–$50 000 for a 12‐week course . This ineffective reimbursement policy in Hong Kong was the main reason leading to such a low treatment uptake and low SVR rates.…”

Section: Discussionmentioning

confidence: 95%

“…Yet our previous cost-effectiveness analysis showed that even with the current local price ranging from US$30 000-$50 000 for a 12-week course. 24 This ineffective reimbursement policy in Hong Kong was the main reason leading to such a low treatment uptake and low SVR rates. As the treatment uptake of PegIFN/RBV was not high and treatment is not effective in more than 60% of patients, retreatment with DAA would be required in 40% of PegIFN/RBV-treated patients.…”

Section: Discussionmentioning

confidence: 99%

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Change in treatment paradigm in people who previously injected drugs with chronic hepatitis C in the era of direct‐acting antiviral therapy

Wong¹,

Chan

Loo

et al. 2019

J of Gastro and Hepatol

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Background Chronic hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs but is often undiagnosed. The treatment paradigm for HCV patients has been changing since the availability of direct‐acting antiviral (DAA) treatment. We aimed to evaluate the change in treatment paradigm of people who previously injected drugs (ex‐PWID) in Hong Kong before and after the availability of DAA. Method Consecutive ex‐PWID referred from various nongovernmental organizations attended education talks at rehabilitation centers and received point‐of‐care rapid test for HCV antibody (anti‐HCV) at the same session. Subjects tested positive for anti‐HCV were invited to undergo further assessment. Afterwards, the patients were referred to the regional hospitals for follow‐up and/or treatment. Results Three hundred sixty‐five ex‐PWID received HCV rapid test; 268 (73.4%) were found to be anti‐HCV positive. Among these 268 HCV‐positive ex‐PWID, 234 (87.3%) attended the assessment session (mean age 52 years, 90.2% male, 45.5% genotype 1b, 41.1% genotype 6a, and median liver stiffness 5.9 kPa); 187 (69.8%) attended follow‐up visits at regional hospitals. Seventy‐one patients received antiviral treatment for HCV; 69 first received peginterferon and ribavirin (PegIFN/RBV), whereas 10 patients (eight PegIFN/RBV‐treated patients) received DAA treatment. Fifty‐two patients achieved sustained virologic response at 12 or 24 weeks. Treatment uptake rates of PegIFN/RBV and DAA treatment in the pre‐DAA versus post‐DAA era were 22.3% versus 48.5% and 0% versus 15.6%, respectively. Conclusions Targeted screening in ex‐PWID is effective in identifying patients with HCV infection in the community. To improve treatment uptake, further improvements in the referral system and treatment regimens are needed.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Change in treatment paradigm in people who previously injected drugs with chronic hepatitis C in the era of direct‐acting antiviral therapy

Wong¹,

Chan

Loo

et al. 2019

J of Gastro and Hepatol

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“…Secondly, these studies do not target the HIV positive MSM population, and consequently do not have any implication on micro-elimination strategies. Thirdly, the cost-effectiveness studies conducted in other Asian countries are from Hong Kong, 17 , 18 Japan, 19 and Singapore, 20 which are high-income countries and therefore not comparable to Thailand. Among other comparable low- and middle-income resource settings, China 21 did not find it cost-effective to use DAAs; a study conducted in Vietnam 22 found DAAs cost-effective but took interferon-based treatments as a comparison, while another study in India 23 uses no DAAs as a comparison scenario while concluding that they are cost-effective.…”

Section: Discussionmentioning

confidence: 99%

Expanding reimbursement of immediate treatment using direct acting antivirals to reduce hepatitis C incidence among HIV positive men who have sex with men in Bangkok, Thailand: A cost effectiveness modelling study

Mukherjee

Colby

Ramautarsing

et al. 2021

Journal of Virus Eradication

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Background Increasing number of hepatitis C virus (HCV) infections among HIV positive men whohave sex with men (MSM) as in an acute HIV infection cohort study in Bangkok, reached an incidence of 45/1000 person-years in 2018. Direct-acting antivirals (DAAs), that cure HCV infection and thereby can prevent transmission, are expensive, their reimbursement being presently delayed to the chronic stages of liver fibrosis. The aim of this study was to determine the cost-effectiveness of immediate DAA treatment to reduce HCV transmission among HIV positive MSM in Bangkok. Methods A deterministic transmission model was calibrated to the HCV epidemic among HIV positive MSM in Bangkok. We compared the current practice of starting DAAs at METAVIR stage F2 rather than at stage F1, or immediately after diagnosis, at stage F0. Cost-effectiveness was examined from a payer's perspective, using a 3% annual discounting rate. Results Compared to the incidence in 2018, delaying DAA treatment to METAVIR stage F2 or F1, increases HCV incidence in 2030 to 63/1000 person-years and 56/1000 person-years, respectively. Conversely, immediate DAA treatment reduces the incidence to 26/1000 person-years. Compared to initiating treatment at stage F2, immediate treatment is cost saving within seven years and saves $17 million over 40 years. One-way sensitivity analysis showed that lower cost savings were achieved at a higher price of DAA treatment and at less frequent HCV screening. Conclusion Immediate DAA treatment is cost saving and increases health benefits by reducing HCV incidence among HIV-infected MSM.

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“…In a previous model of GT1infected CHC patients using a decision tree structure, SOF, LDV/SOF, and OMB/PAR/RIT + DAS were all cost-effective compared to PegIFN + RBV, regardless of treatment history and presence of cirrhosis, with ICURs less than US$30,000 per additional cure [62]. In addition, hypothetical highly effective DAAs (defined as having an SVR of 100%) were projected to be the most cost-effective compared to PegIFN + RBV at a price of up to US$43,553 in countries where SOF + PegIFN + RBV is the standard of practice and up to US$56,985 where boceprevir + PegIFN + RBV is the standard [56]. Actual costs of DAAs in Hong Kong (Table 3) are lower than these estimates, further supporting the agents' cost-effectiveness versus PegIFN + RBV.…”

Section: Discussionmentioning

confidence: 99%

Cost–Utility of All-Oral Direct-Acting Antiviral Regimens for the Treatment of Genotype 1 Chronic Hepatitis C Virus-Infected Patients in Hong Kong

et al. 2020

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Background Direct-acting antivirals (DAAs) are entering the hepatitis C virus (HCV) treatment landscape in Hong Kong, prompting the need for cost–effectiveness evaluations of these interventions to enable optimal use of healthcare resources. Aims This study aimed to compare the cost–effectiveness of DAAs to standard-of-care pegylated interferon plus ribavirin (RBV) in treatment-naïve patients without significant liver fibrosis and to compare different DAAs in patients who are treatment-experienced and/or have advanced liver disease. Methods A Markov model was constructed to evaluate cost–effectiveness over a lifetime time horizon from the payer perspective. The target population was treatment-naïve and treatment-experienced HCV genotype 1 patients, stratified by degree of liver fibrosis. The model consists of 16 health states encompassing METAVIR fibrosis score (F0–F4), treatment success or failure, decompensated cirrhosis, hepatocellular carcinoma, liver transplant, and liver-related death. The proportions of patients achieving sustained virologic response were obtained from clinical trials. Other inputs were obtained from published and local data. The primary outcome was incremental cost–utility ratio for each DAA versus pegylated interferon + ribavirin and among different DAAs. Results In treatment-naïve F0–2 HCV patients, all DAAs were cost-effective in genotype 1a and daclatasvir + asunaprevir, elbasvir/grazoprevir, ledipasvir/sofosbuvir, and glecaprevir/pibrentasvir were cost-effective compared to pegylated interferon + ribavirin in genotype 1b. In genotypes 1a and 1b, treatment-experienced patients, and F3–4 patients, elbasvir/grazoprevir was the least costly DAA and economically dominant over most other DAAs. Conclusions DAAs can be a cost-effective option for the treatment of genotype 1 HCV patients in Hong Kong, and elbasvir/grazoprevir is cost-effective.

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Cost‐effectiveness of the highly effective direct‐acting antivirals in the treatment of chronic hepatitis C in Hong Kong

Abstract: The most desirable costs of the Highly Effective DAAs would be below US$43,553 if Sofosbuvir-PR rescue therapy is used and below US$56,985 if Boceprevir-PR therapy is used.

Cited by 6 publications

References 40 publications

Change in treatment paradigm in people who previously injected drugs with chronic hepatitis C in the era of direct‐acting antiviral therapy

Change in treatment paradigm in people who previously injected drugs with chronic hepatitis C in the era of direct‐acting antiviral therapy

Expanding reimbursement of immediate treatment using direct acting antivirals to reduce hepatitis C incidence among HIV positive men who have sex with men in Bangkok, Thailand: A cost effectiveness modelling study

Cost–Utility of All-Oral Direct-Acting Antiviral Regimens for the Treatment of Genotype 1 Chronic Hepatitis C Virus-Infected Patients in Hong Kong

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