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The value of cure associated with treating treatment‐naïve chronic hepatitis C genotype 1: Are the new all‐oral regimens good value to society?
Author(s) -
Younossi Zobair M.,
Park Haesuk,
Dieterich Douglas,
Saab Sammy,
Ahmed Aijaz,
Gordon Stuart C.
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13298
Subject(s) - medicine , sofosbuvir , paritaprevir , dasabuvir , ombitasvir , ledipasvir , simeprevir , ribavirin , ritonavir , hepatitis c , daclatasvir , pegylated interferon , hepatitis c virus , viral load , virology , virus , antiretroviral therapy
Background & Aims All‐oral regimens are associated with high cure rates in hepatitis C virus‐genotype 1 ( HCV ‐ GT 1) patients. Our aim was to assess the value of cure to the society for treating HCV infection. Methods Markov model for HCV ‐ GT 1 projected long‐term health outcomes, life years, and quality‐adjusted life years ( QALY s) gained. The model compared second‐generation triple (sofosbuvir+pegylated interferon+ribavirin [ PR ] and simeprevir+ PR ) and all‐oral (ledipasvir/sofosbuvir and ombitasvir+paritaprevir/ritonavir+dasabuvir±ribavirin) therapies with no treatment. Sustained virological response rates were based on Phase III RCT s. We assumed that 80% and 95% of HCV ‐ GT 1 patients were eligible for second‐generation triple and all‐oral regimens. Transition probabilities, utility and mortality were based on literature review. The value of cure was calculated by the difference in the savings from the economic gains associated with additional QALY s. Results Model estimated 1.52 million treatment‐naïve HCV ‐ GT 1 patients in the US . Treating all eligible HCV ‐ GT 1 patients with second‐generation triple and all‐oral therapies resulted in 3.2 million and 4.8 million additional QALY s gained compared to no treatment respectively. Using $50,000 as value of QALY , these regimens lead to savings of $185 billion and $299 billion; costs of these regimens were $109 billion and $128 billion. The value of cure with second‐generation triple and all‐oral regimens was $55 billion and $111 billion, when we conservatively assumed only drug costs. Cost savings were greater for HCV ‐ GT 1 patient cured with cirrhosis compared to patients without cirrhosis. Conclusions The recent evolution of regimens for HCV GT 1 has increased efficacy and value of cure.