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Cost-Effectiveness Analysis of Oral Direct-Acting Antivirals for Chinese Patients with Chronic Hepatitis C

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Abstract

Background and Objective

All oral direct-acting antivirals (DAAs) have shown excellent efficacy and safety in Chinese patients with chronic hepatitis C (CHC). However, the cost of DAAs used to be expensive; therefore, large numbers of patients had no access to DAAs in China. Recently, prices have been greatly reduced. The objective of this study was to evaluate the cost-effectiveness of ledipasvir/sofosbuvir (LDV/SOF), sofosbuvir/velpatasvir (SOF/VEL), elbasvir/grazoprevir (EBR/GZR) and glecaprevir/pibrentasvir (GLE/PIB) in Chinese CHC patients stratified by hepatitis C virus (HCV) genotype (GT), cirrhosis status, and treatment history.

Methods

On the basis of a Chinese healthcare perspective, a Markov model was constructed to estimate the lifetime costs and health outcomes of patients treated with different DAA regimens. Chinese-specific clinical, cost, and utility inputs were obtained or calculated from published sources and expert opinions. Costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were reported as primary outcomes. Base-case analysis and sensitivity analysis were conducted.

Results

At a willing-to-pay (WTP) threshold of US$30,081/QALY (calculated by three times the GDP per capita in China), SOF/VEL was cost-effective in patients with HCV GT 1, 3, and 6 infections, and the probabilities that SOF/VEL was cost-effective were 9.7–75.7%, 39.1–63.9%, and 35.6–88.0%, respectively. For GT2 patients, noncirrhotic patients, treatment-naïve patients, and treatment-experienced patients, LDV/SOF was the most cost-effective regimen, and the probabilities of cost-effectiveness for each of these groups was 92.1–99.8%, 89.9–99.0%, 61.6–91.2%, and 99.3–100.0%, respectively below the WTP threshold. The GLE/PIB regimen (12-week duration) was the most cost-effective in cirrhotic patients, whereas the probability of its cost-effectiveness varied with that of EBR/GZR (4.1–93.8% versus 6.2–93.3%) below the WTP threshold.

Conclusions

Overall, SOF/VEL and LDV/SOF regimens are more likely to be cost-effective among various subgroups of Chinese patients with CHC.

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Author notes

  1. Co-first authors: Pingyu Chen and Min Jin contributed equally to this work.

Authors and Affiliations

  1. Department of Health Economics, China Pharmaceutical University, Nanjing, China

    Pingyu Chen, Min Jin, Yang Cao & Hongchao Li

  2. Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China

    Pingyu Chen & Hongchao Li

Authors
  1. Pingyu Chen
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  2. Min Jin
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  3. Yang Cao
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  4. Hongchao Li
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Corresponding author

Correspondence to Hongchao Li.

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Conflicts of interest

The authors have declared that no competing interests exist.

Author contributions

PYC and HCL were responsible for the study design. PYC and HCL completed the model building. PYC, MJ, and YC completed data collection, under the guidance of HCL. MJ and PYC performed the meta-analysis, statistical analysis and interpreted the data. YC investigated the model validation. PYC and MJ contributed to the writing. HCL checked and revised the manuscript. All the authors approved the final manuscript.

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All the data are presented in the manuscript and the Electronic Supplemental Material.

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Chen, P., Jin, M., Cao, Y. et al. Cost-Effectiveness Analysis of Oral Direct-Acting Antivirals for Chinese Patients with Chronic Hepatitis C. Appl Health Econ Health Policy 19, 371–387 (2021). https://doi.org/10.1007/s40258-020-00623-3

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