Hepatitis C

Which Hep C Treatments Are The Most Cost-Effective?

Newer hepatitis C (HCV) regimens have shorter treatment periods and increased rates of sustained viralogic response compared to the existing therapies, but are much more expensive.

In order to evaluate the cost-effectiveness of these treatments, researchers conducted a review examining treatment-naïve participants with chronic HCV genotype 1, 2, and 3.
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“Usual care (boceprevir–ribavirin–pegylated interferon [PEG]) was compared with sofosbuvir–ribavirin–PEG and 3 PEG-free regimens: sofosbuvir–simeprevir, sofosbuvir–daclatasvir, and sofosbuvir–ledipasvir,” said the study’s researchers.

“For genotypes 2 and 3, usual care (ribavirin–PEG) was compared with sofosbuvir–ribavirin, sofosbuvir–daclatasvir, and sofosbuvir–ledipasvir–ribavirin (genotype 3 only),” they said.

Assuming that sofosbuvir, simeprevir, daclastasvir, and ledipasvir cost $7000, $5500, $5500, and $875, respectively, researchers found that sofosbuvir-ledipasvir appeared to be the most cost-effective for genotype 1. The drugs cost $12,825 more per quality-adjusted life-years (QALY) compared to usual care.

For genotype 2, sofosbuvir-ribavirin cost $110,000 and sofosbuvir-daclatasvir cost $691,000 per QALY.

Further, sofosbuvir-ledipasvir-ribavirin cost $73,000 per QALY, sofosbuvir-declastasvir cost over $396,000 per QALY at assumed prices, and sofosbuvir-ribavirin was more expensive and less effective than usual care for genotype 3.

The researchers discovered that sofobuvir-ledipasvir was the optimal strategy for genotype 1 and would be cost-effective if the drug cost less than $5500.

For genotype 2, sofosbuvir-ribavirin-PEG would be cost-efficient if sofobuvir cost less than $2250 every week, and sofosbuvir-ledipasvir-ribavirin would be the most cost-saving for genotype 3 if sofosbuvir cost less than $1500 per week.

The complete study is published in the March issue of Annals of Internal Medicine.

-Michelle Canales Butcher

Reference:

Najafzadeh M, Andersson K, Shrank WH, et al. Cost-effectiveness of novel regiments for the treatment of hepatitis C virus. Ann Intern Med. 2015 March [epub ahead of print] doi: 10.7326/M14-1152.