Study Examines Cost-Effectiveness of New Hepatitis C Virus Treatments in VA and Non-VA Patient Populations
BACKGROUND:
New chronic hepatitis C virus (HCV) treatment regimens that include second-generation direct-acting antivirals, which have fewer side effects, have led to substantial increases in the number of patients initiating therapy. However, treatment costs for the approximately three million people with HCV in the U.S. could exceed $100 billion. A majority of these costs would be due to treatment-naïve (have never received treatment) genotype 1 HCV mono-infected patients. Further, high treatment costs pose exceptional challenges to healthcare systems with large numbers of patients with HCV; for example, VA has more than 100,000 Veterans with HCV who are treatment-naïve. This study analyzed the cost-effectiveness of multiple new HCV treatments for VA and non-VA treatment-naïve patients, accounting for differences in patient characteristics and costs of ongoing care and current drug prices, as well as potential reductions in these prices. In addition to cost, main outcomes included sustained virologic response (SVR), advanced liver disease, and quality adjusted life years (QALYs). Investigators evaluated several approved HCV antiviral medications, including: sofosbuvir/ledipasvir (SOF-LDV), ombitasvir/paritaprevir/ritonavir/dasabuvir (3D), sofosbuvir/simeprevir (SOF-SMV), and pedylated interferon/ribavirin (PEG-RBV).
FINDINGS:
- In the non-VA HCV population, the latest generation of highly effective but costly HCV treatments delivers good value – comparable to other medical interventions commonly deemed high value. HCV treatment is even more cost-effective in VA's patient population due to VA's lower costs of drugs, despite patients being older with more comorbid conditions.
- Based on data from clinical trials, this model-based analysis indicated that the most effective regimen was 3D, which achieved SVR in 97% of both VA and non-VA patients, followed closely by SOF-LDV and SOF-SMV. Both SOF-LDV and 3D reduced advanced liver disease (>20% relative to no treatment) and increased QALYs by >2 years per person. SOF-LDV and 3D are even more cost-effective for VA, though VA aggregate treatment costs would still exceed $4 billion at SOF-LDV prices of $3,308 per week, per patient. Actual effectiveness in VA may differ from trial results.
- The least effective regimen in both VA and non-VA patient populations was PEG-RBV.
LIMITATIONS:
- This study focused on VA and the general U.S. healthcare system, and did not include other large providers of HCV care (i.e., Medicare, Medicaid, and prison health systems).
- Drug prices used for this study analysis were similar to – but not identical to prices actually paid by VA, thus actual VA costs may differ and will change as drug prices change.
- This analysis used rates of SVR similar to randomized trials. In practice, SVR rates may be lower, which will make the cost-effectiveness less favorable than was estimated.
AUTHOR/FUNDING INFORMATION:
This study was partly supported by HSR&D (IIR 12-059). Drs. Barnett, Gidwani, Asch, and Owens are part of HSR&D's Center for Innovation to Implementation (Ci2i) in Palo Alto, CA.
Liu S, Barnett P, Holodniy M, Lo J, Joyce V, Gidwani R, Asch S, Owens D, and Goldhaber-Fiebert J. Cost-Effectiveness of Treatments for Genotype 1 Hepatitis C Virus Infection in non-VA and VA Populations. Medical Decision Making Policy & Practice. October 3, 2016.
