Treatment of hepatitis C virus leads to economic gains related to reduction in cases of hepatocellular carcinoma and decompensated cirrhosis in Japan

Abstract

Hepatocellular carcinoma (HCC) is a serious complication of hepatitis C virus (HCV) infection. Sustained virologic response (SVR) for HCV is associated with a reduction in cirrhosis, HCC and mortality and their associated costs. Japanese HCV patients are older with higher prevalence of HCC. Here we used a decision-analytic Markov model to estimate the economic benefit of HCV cure by reducing HCC and DCC burden in Japan. A cohort of 10 000 HCV genotype 1b (GT1b) Japanese patients was modelled with a hybrid decision tree and Markov state-transition model capturing natural history of HCV over a lifetime horizon. Treatment options were approved all-oral direct-acting anti-virals (DAAs) vs no treatment. Treatment efficacy was based on clinical trials and transition rates and costs obtained from Japan-specific data. Cases of HCC, decompensated cirrhosis (DCC) and quality-adjusted life years (QALYs) were projected for patients treated with DAAs vs NT. QALYs were monetized using a willingness-to-pay threshold of ¥4-to-¥6 million. Incremental savings with treatment were calculated by adding the projected cost of complications avoided to the monetized gains in QALYs. The model showed that DAA treatment vs no treatment, reduces 2057 cases of HCC and 1478 cases of decompensated cirrhosis and saves ¥850 446.73 and ¥338 229.90 per patient (ppt). Additionally, treatment can lead to additional 2.64 QALYs gained per patient. The indirect economic gains associated with treatment-related QALY improvements were ¥10 576 000, ¥13 220 000 and ¥15 864 000 ppt (willingness-to-pay thresholds of ¥4 million, ¥5 million and ¥6 million). Total economic savings of treatment with DAAs (vs no treatment) was ¥7 526 372.63, ¥10 170 372.63 and ¥12 814 372.63, at these different willingness-to-pay thresholds. In conclusion treatment of HCV GT1b with all-oral DAAs in Japan can lead to significant direct and indirect savings related to avoidance of HCC and DCC.

Impact of All‐Oral Direct‐Acting Antivirals on Clinical and Economic Outcomes in Patients With Chronic Hepatitis C in the United States

“…Although we did not observe decreased costs in the DAA group among patients without cirrhosis, we believe that over time the savings associated with the avoidance of advanced liver disease and other complications of HCV will be offset, as predicted by several economic investigations in which DAA therapy was found to be cost-effective in the long term. (16)(17)(18)31) Furthermore, although we did not study HCV-associated extrahepatic manifestations in this study, previous investigators found that a large proportion of all-cause medical costs were attributable to extrahepatic manifestation-related costs in patients with HCV, adding strength to our findings that treatment with DAAs can reduce the high medical costs in patients with HCV by saving in both liver complications and extrahepatic manifestations avoided with cure. (14,32,33) It is important to note that in our economic analysis, we estimated that the costs for at least an 8-week DAA treatment course ranged between approximately $100,467 and $123,086.…”

Safety and efficacy of sofosbuvir‐based direct‐acting antiviral regimens for hepatitis C virus genotype 6 in Southwest China: Real‐world experience of a retrospective study

“…Additionally, DAA therapy does not increase the risk of HCC recurrence but does decrease the risk of waitlist dropout due to tumour progression or death . Using a hybrid decision tree model and a Markov state transition model to capture the natural history of HCV over a lifetime horizon of a cohort of 10 000 GT1 CHC patients, one study from Japan indicated that treatment with DAAs could eliminate HCC in 2057 cases and decompensated cirrhosis in 1478 cases, thus leading to significant direct and indirect economic gains …”

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

“…In non-cirrhotic patients, the disease progression is stopped when SVR12 is achieved. Patients with cirrhosis may still develop decompensated cirrhosis (DCC) or hepatocellular carcinoma (HCC) despite reaching SVR12, but the likelihood of this is significantly lower compared to patients without SVR12 [28]. The transition probabilities are derived from available literature and shown in Table 2.…”