Economic evaluation of a population strategy for the treatment of chronic hepatitis C with direct-acting antivirals

Abstract

The high initial cost of antivirals against hepatitis C prompted development of the "Strategic Plan for Tackling Chronic Hepatitis C in the Spanish National Health System". The objective of this study was the economic evaluation of the first two years of its application in Navarre, Spain. The change in the natural history of hepatitis C produced by the sustained virological response (SVR) was compared to an alternative without treatment and modeled with patient-level data. By means of a discrete events simulation model, the cost-effectiveness and the budget impact analysis of the treatment program were measured from the perspective of the Navarre Health Service. Of 656 patients treated, 98% had SVR. The average cost of the treatments was 18,743 euros per patient. The incremental cost-effectiveness ratio (ICER) with discount was 5,346 euros per quality-adjusted life years, which became more efficient as the stage of fibrosis increased until it reached levels of dominance in stage 4 fibrosis. The associated costs for chronic liver disease decreased as the benefit of the treatment was expressed. The implementation of the Strategic Plan is cost-effective, with an ICER well below the threshold, since the cost of treatment is largely compensated by savings in long-term health expenditure. The budgetary impact foresees a net saving from the third year on. The two key parameters were the decrease in the price of the treatment and the SVR in nearly 100% of the patients.

Clinical and economic value of sofosbuvir-based regimens in the treatment of chronic hepatitis C in Spain

“…Other studies that have analysed the efficiency of DAAs have shown similar results of health outcomes, showing that they are greater than those yielded by previous therapies and that DAA treatment would reduce the costs of the disease, generating savings in the cost of health care and improving long-term health [ 4 , 5 , 38 , 39 ].…”

“…DAA treatment would reduce the costs of the disease, generating savings in the cost of health care and improving long-term health [4,5,38,39].…”

Budget impact analysis of the use of Souvenaid in patients with prodromal Alzheimer’s Disease in Spain

“…The idea that a treatment may be cost-effective, but cannot be adopted due to its budgetary impact, was raised a few years ago concerning hepatitis C [ 44 ] and has appeared more recently in the field of AD [ 45 ]. In 2015, the evaluation of hepatitis C treatments was summarized paradoxically as “cost-effective but unaffordable” [ 44 , 46 , 47 ]. Over the subsequent years, the reality has been different, most of the millions of patients with hepatitis C in Europe having eventually been treated, and the debate is now focused on its eradication [ 48 ].…”

“…Over the subsequent years, the reality has been different, most of the millions of patients with hepatitis C in Europe having eventually been treated, and the debate is now focused on its eradication [48]. The impossible became possible because the price per patient for the treatments fell from an initial €100,000 [47] to €18,000 [46] and because their added health benefits, specifically, avoiding the progression towards chronic liver disease, were taken into account [49].…”

Eliminación de la hepatitis C. Documento de posicionamiento de la Asociación Española para el Estudio del Hígado (AEEH)

“…A estos pacientes se de-ben sumar los miles de enfermos tratados con regímenes basados en interferón en las últimas dos décadas, lo que probablemente supone cerca de 150.000 pacientes curados (3). Este plan, pionero a nivel mundial, ha permitido poner a España en el foco de los países que más han avanzado para conseguir los objetivos marcados por la OMS para la eliminación de la hepatitis C en el año 2030 (13). Pero pese a esos excelentes datos, se estima que en el ámbito de la población general que acude a la atención primaria hay todavía 76.500 personas virémicas.…”