Cost-effectiveness of novel treatment of hepatitis C virus in Lebanese patients

  • Soumana C. Nasser
  • Hanine Mansour
  • Tatiana Abi Nader
  • Mirna Metni
Research Article

Abstract

Background Limited data is available on Hepatitis C disease prevalence, treatment initiation and its cost-effectiveness in Lebanon and the whole Middle East. Objective The aim of the study is to assess whether initiation of novel Direct Acting Antiviral agents (DAAs) at early stage of hepatitis C is cost-effective in Lebanese patients. Setting Lebanon. Methods This modeling study was conducted from the perspective of Lebanese third party payers, where existing practice is based on international guidelines for the diagnosis and treatment of diseases. The model assessed cost-effectiveness of early versus delayed DAAs treatment in a standard patient upon HCV diagnosis. Medical costs were valued using in-house database. Main outcome measures Incremental Cost-Effectiveness Ratio (ICER) per QALY and per life-year extended. Results Treatment at early HCV disease stage has led to an ICER of 587 euro per QALY gained throughout the course of the disease. Outcomes of early treatment with DAAs upon HCV diagnosis led to an incremental cost of 27,268 euro per QALY gained at first year of treatment, and of 1527 euro per additional life-year extended. Sensitivity analysis showed that a 25% decrease in the cost of dual drug option resulted in a decrease of incremental cost to 16,982 euro per QALY gained at first year of treatment with DAAs upon early HCV diagnosis. Conclusion Decision makers are encouraged to reinforce the need to screen for HCV and initiate novel treatment at early disease stage in the Lebanese healthcare system.

Keywords

Cost-effectiveness Delayed treatment Direct acting anti-viral agents Early treatment Hepatitis C virus Lebanon QALYs 

Notes

Acknowledgements

Authors would like to acknowledge Dr Natalia Argente, at University of Pompeu Fabra, for providing feedbacks on study design, and Dr Lamis Karaoui, at the Lebanese American University, for editing the writing of the manuscript.

Funding

None.

Conflicts of interest

All authors declare that they have no conflicts of interest.

References

  1. 1.
    Averhoff FM, Glass N, Holtzman D. Global burden of hepatitis C: considerations for healthcare providers in the United States. Clin Infect Dis. 2012;55(1):S10–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention. Surveillance for viral hepatitis—United States, 2012. http://www.cdc.gov/hepatitis/statistics/2012surveillance/commentary.htm. Accessed 20 Dec 2016.
  3. 3.
    Mena A, Moldes L, Meijide H, Canizares A, Castro-Iglesias A, Delgado M, et al. Seroprevalence of HCV and HIV infections by year of birth in Spain: impact of US CDC and USPSTF recommendations for HCV and HIV testing. PLoS ONE. 2014;9(12):e113062.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chemaitelly H, Chaabna K, Abu-Raddad LJ. The epidemiology of hepatitis C virus in the fertile crescent: systematic review and meta-analysis. PLoS ONE. 2015;10(8):e0135281.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Abou Rached A, Abou Kheir S, Saba J, Ammar W. Epidemiology of hepatitis B and C in general population in Lebanon. Arab J Gastroenterol. 2016;17(1):29–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today’s treatment paradigm. J Viral Hepat. 2014;21(1):34–59.CrossRefPubMedGoogle Scholar
  7. 7.
    Abou Rached A, Yaghi C, Khalil L, Saba J, Ammar W. Prevalence of hepatitis C virus genotypes and subtypes in Lebanese population and major high risk groups. Arab J Gastroenterol. 2017;18(2):114–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Daw MA, Dau AA. Hepatitis C virus in Arab world: a state of concern. Sci World J. 2012;2012:719494.Google Scholar
  9. 9.
    American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA). Recommendations for Testing, Managing, and Treating Hepatitis C. 2017. http://www.hcvguidelines.org. Accessed 5 Apr 2017.
  10. 10.
    Leidner AJ, Chesson HW, Xu F, Ward JK, Spradling PR, Holmberg SD. Cost-effectiveness of hepatitis C treatment for patients in early stages of liver disease. Hepatology. 2015;61(6):1860–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Obach D, Deuffic-Burban S, Esmat G, Anwar WA, Dewedar S, Canva V, et al. Effectiveness and cost-effectiveness of immediate versus delayed treatment of hepatitis C virus-infected patients in a country with limited resources: the case of Egypt. Clin Infect Dis. 2014;58(8):1064–71.CrossRefPubMedGoogle Scholar
  12. 12.
    Pawlotzky JM, Feld J, Zeuzem S, Hoofnagle J. From non-A, non-B hepatitis to hepatitis C virus cure. J Hepatol. 2015;62(1):S87–99.CrossRefGoogle Scholar
  13. 13.
    Saab S, Hunt DR, Stone MA, McClune A, Tong MJ. Timing of hepatitis C antiviral therapy in patients with advanced liver disease: a decision analysis model. Liver Transpl. 2010;16(6):748–59.PubMedGoogle Scholar
  14. 14.
    Hutchinson SJ, Bird SM, Goldberg DJ. Modeling the current and future disease burden of hepatitis C among injection drug users in Scotland. Hepatology. 2005;42:711–23.CrossRefPubMedGoogle Scholar
  15. 15.
    McLernon DJ, Dillon J, Donnan PT. Health-state utilities in liver disease: a systematic review. Med Decis Mak. 2008;28(4):582–92.CrossRefGoogle Scholar
  16. 16.
    Cortesi PA, Scalone L, Ciampichini R, Cozzolino P, Cesana G, Mantovani LG, et al. The impact of type of liver conditions on the patients’ health related quality of life. Value Health. 2013;16(7):A500.CrossRefGoogle Scholar
  17. 17.
    Maor Y, Malnick SDH, Melzer E, Leshno M. Treatment of chronic hepatitis C in the aged—Does it impact life expectancy? A decision analysis. PLoS ONE. 2016;11(7):e0157832.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Alazawi W, Cunningham M, Dearden J, Foster GR. Systematic review: outcome of compensated cirrhosis due to chronic hepatitis C infection. Aliment Pharmacol Ther. 2010;32(3):344–55.CrossRefPubMedGoogle Scholar
  19. 19.
    Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology. 2008;48(2):418–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Shepherd J, Jones J, Hartwell D, Davidson P, Price A, Waugh N. Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and economic evaluation. Health Technol Assess. 2007;11(11):1–205.CrossRefPubMedGoogle Scholar
  21. 21.
    Chahal HS, Marseille EA, Tice JA, Pearson SD, Ollendorf DA, Fox RK, et al. Cost-effectiveness of early treatment of hepatitis C virus genotype 1 by stage of liver fibrosis in a US treatment-naive population. JAMA Intern Med. 2016;176(1):65–73.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Chidi A, Bryce C, Donohue J, Fine M, Landsittel D, Myaskovsky L, Rogal S, et al. Economic and public health impacts of policies restricting access to hepatitis C treatment for medicaid patients. Value Health. 2016;19(4):326–34.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bruggmann P, Grebely J. Prevention, treatment, and care for hepatitis C virus infection among people who inject drugs. Int J Drug Policy. 2015;26:S22–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Duberg AS, Blach S, Falconer K, Kaberg M, Razavi H, Aleman S. The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies. Scand J Gastroenterol. 2015;50(2):233–44.CrossRefPubMedGoogle Scholar
  25. 25.
    Cortesi PA, Ciaccio A, Rota M, Lim JK, De Salvia S, Okolicsanyi S, et al. Management of treatment-naıve chronic hepatitis C genotype 1 patients: a cost-effectiveness analysis of treatment options. J Viral Hepat. 2015;22(2):175–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Soumana C. Nasser
    • 1
  • Hanine Mansour
    • 1
  • Tatiana Abi Nader
    • 1
  • Mirna Metni
    • 2
  1. 1.School of PharmacyLebanese American UniversityByblosLebanon
  2. 2.Medical Control DepartmentLebanese National Security Social FundBeirutLebanon

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