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Cost‐effectiveness and budget impact of interferon‐free direct‐acting antiviral‐based regimens for hepatitis C treatment: the F rench case
Author(s) -
DeufficBurban S.,
Obach D.,
Canva V.,
Pol S.,
RoudotThoraval F.,
Dhumeaux D.,
Mathurin P.,
Yazdanpanah Y.
Publication year - 2016
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12546
Subject(s) - medicine , regimen , cost effectiveness , quality adjusted life year , hepatitis c , stage (stratigraphy) , biology , paleontology , risk analysis (engineering)
Summary We evaluated the cost‐effectiveness and the budget impact of new DAA ‐based regimen use in France. A Markov model simulated chronic hepatitis C ( CHC ) treatment interventions with IFN ‐based and IFN ‐free regimens at stage of fibrosis ≥F3, ≥F2 or regardless of fibrosis stage, and treatment either with the least or the most expensive combination. It estimated quality‐adjusted life years ( QALY s) and incremental cost‐effectiveness ratios ( ICER s). It also assessed the budget impact over 5 years of treating all CHC ‐screened patients, regardless of fibrosis, assuming ≤20 000 patients treated/year and priority to ≥F3. Sensitivity analyses were also conducted. For genotypes (G) 1–4, the initiation of IFN ‐free regardless of fibrosis was a cost‐effective strategy compared to prior standard of care ( SOC ) initiated at stage F2: €40 400–88 300/ QALY gained in G1; similar results were obtained for patients infected with G4. Considering G2–3, the most cost‐effective strategy was IFN ‐based regimens regardless of fibrosis compared to prior SOC initiated at stage F2: €21 300 and €19 400/ QALY gained, respectively; the strategy with IFN ‐free regimens being more effective but not cost‐effective at current costs. The budget impact of treating all CHC ‐screened patients over 5 years would range between 3.5 and 7.2 billion €, depending on whether one considers the least or the most expensive combination of new DAA s and whether one treats G2–3 with IFN ‐based or IFN ‐free new DAA s. In France, treatment initiation with new DDA s regardless of fibrosis stage is cost‐effective, but would add 3.5–7.2 billion € to an already overburdened medical care system.