Systematic review: cost‐effectiveness of direct‐acting antivirals for treatment of hepatitis C genotypes 2‐6

Background The availability of direct‐acting antivirals ( DAA s) has dramatically changed the landscape of hepatitis C virus ( HCV ) therapy; however, the cost and budget requirements for DAA treatment have been widely debated. Aims To systematically review published studies evaluating the cost‐effectiveness of DAA s for HCV genotype 2‐6 infections, and synthesise and re‐evaluate results with updated drug prices. Methods We conducted a systematic search of various electronic databases, including Medline, EMBASE , Cochrane library and EconLit for cost‐effectiveness studies published from 2011 to 2016. Studies evaluating DAA s for genotypes 2‐6 were included. Reported costs, quality‐adjusted life‐years ( QALY s) and incremental cost‐effectiveness ratios ( ICER s) were abstracted. We re‐estimated ICER s by varying the price of DAA s from $20 000 to $100 000, and estimated the threshold price at which DAA regimens would be deemed cost‐effective ( ICER ≤$100 000/ QALY ). Results A total of 92 ICER s for 7 different DAA regimens from 10 published articles were included. Among the abstracted 92 ICER s, 20 were for genotype 2, 40 for genotype 3, 30 for genotype 4, 2 for genotype 5 and none for genotype 6; therefore, only genotypes 2‐5 were analysed. At the discounted price of $40 000, 87.0% analyses found DAA regiments to be cost‐effective, and 7.6% found to be cost‐saving. The median threshold price below which DAA s would be deemed cost‐effective was between $144 400 and $225 000, and cost‐saving between $17 300 and $25 400. Conclusions HCV treatment with DAA s is highly cost‐effective in patients with HCV genotypes 2‐5 at a $100 000/ QALY threshold. Timely HCV treatment would be an optimal strategy from both a public health and economic perspective.