Cost-utility Analysis of Second-generation Direct-acting Antivirals for Hepatitis C
| Author | Zahra Goudarzi | en |
| Author | Abdollah Poursamad | en |
| Author | Iman Karimzadeh | en |
| Author | Nahid Jallaly | en |
| Author | Khosro Keshavarz | en |
| Author | Seyed Moayed Alavian | en |
| Orcid | Iman Karimzadeh [0000-0002-8956-4528] | en |
| Orcid | Khosro Keshavarz [0000-0002-5778-5502] | en |
| Orcid | Seyed Moayed Alavian [0000-0002-4443-6602] | en |
| Issued Date | 2021-08-31 | en |
| Abstract | Background: Hepatitis C virus (HCV) can lead to increased mortality, disability, and liver transplantation if left untreated, and it is associated with a possible increase in disease burden in the future, all of which would surely have a significant impact on the health system. New antiviral regimens are effective in the treatment of the disease yet expensive. Objectives: The purpose of the present study was to assess the cost-effectiveness of three medication regimens, namely, ledipasvir/sofosbuvir (LDV/SOF), velpatasvir/sofosbuvir, and daclatasvir/sofosbuvir (DCV/SOF) for HCV patients with genotype 1 in Iran. Methods: A Markov model with a lifetime horizon was developed to predict the costs and outcomes of the three mentioned medication therapy strategies. The final outcome of the study was quality-adjusted life-years (QALYs), which was obtained using the previously published studies. The study was conducted from the perspective of the Health Ministry; therefore, only direct medical costs were estimated. The results were provided as the incremental cost-effectiveness ratio (ICER) per QALY. Ultimately, the one-way and probabilistic sensitivity analyses were used to measure the strength of study results. Results: The results showed that the QALYs for LDV/SOF, DCV/SOF, and VEL/SOF were 13.25, 13.94, and 14.61, and the costs were 4,807, 7,716, and 4,546$, respectively. The VEL/SOF regimen had lower costs and higher effectiveness than the LDV/SOF and DCV/SOF regimens, making it a dominant strategy. The tornado diagram results showed that the study results had the highest sensitivity to chronic hepatitis C (CHC) and compensated cirrhosis (CC) state costs. Moreover, the scatter plots showed that the VEL/SOF was the dominant therapeutic strategy in 73% of the simulations compared to LDV/SOF and 66% of the simulations compared to DCV/SOF; moreover, it was in the acceptable region in 92% of the simulations and below the threshold. Therefore, it was considered the most cost-effective strategy. Moreover, the results showed that DCV/SOF was in the acceptable region below the threshold in 69% of the simulations compared to LDV/SOF. Therefore, the DCV/SOF regimen was more cost-effective than LDV/SOF. Conclusions: According to the present study results, it is suggested that the VEL/SOF regimen be used as the first line of therapy in patients with HCV genotype 1. Moreover, DCV/SOF can be the second-line medication regimen. | en |
| DOI | https://doi.org/10.5812/hepatmon118646 | en |
| Keyword | Cost-effectiveness Analysis | en |
| Keyword | Hepatitis C Virus | en |
| Keyword | Genotype1 | en |
| Keyword | New Antiviral Regimens | en |
| Keyword | Direct-acting Antiviral Agents | en |
| Keyword | Markov Modeling | en |
| Keyword | Probabilistic Sensitivity Analysis | en |
| Publisher | Brieflands | en |
| Title | Cost-utility Analysis of Second-generation Direct-acting Antivirals for Hepatitis C | en |
| Type | Research Article | en |