Skip to main content

Advertisement

SpringerLink
Log in

Budget impact and cost-effectiveness analyses of direct-acting antivirals for chronic hepatitis C virus infection in Hong Kong

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The purpose of this investigation was to evaluate the budget impact and cost-effectiveness of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection in Hong Kong. A decision analytic model was developed to compare short-term costs and health outcomes of patients with chronic HCV genotype 1 infection in Hong Kong who were treated with an interferon (INF)-based treatment (dual therapy of pegylated interferon and ribavirin) or DAA-based treatments (sofosbuvir or ledipasvir/sofosbuvir or ombitasvir/paritaprevir/ritonavir plus dasabuvir). Compared to INF-based treatment, DAA-based treatments yielded an incremental cost of $24,677–$31,171 per course while improving the rate of sustained virologic response (SVR) from 59–66% to 82.3–99.8%. The incremental cost-effective ratios of DAA-based treatments ranged from $9724 to $29,189 per treatment success, which were all below the cost-effectiveness threshold of local GDP per capita ($42,423 in 2015). Introducing DAAs resulted in a 126.1% ($383.7 million) budget increase on HCV infection management over 5 years. A 50% change in DAA medication costs reflected a change in the incremental budget from $55.2 to $712.3 million. DAA-based treatments are cost-effective alternatives to INF-based treatment in Hong Kong. Introducing DAAs to the public hospital formulary yields a considerable budget increase but is still economically favorable to the local government.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. World Health Organization (WHO) (2016) Hepatitis C fact sheet. Available online at: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed 13 Sep 2016

  2. Lozano R, Naghavi M, Foreman K et al (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2095–2128

    Article  PubMed  Google Scholar 

  3. Averhoff FM, Glass N, Holtzman D (2012) Global burden of hepatitis C: considerations for healthcare providers in the United States. Clin Infect Dis 55(Suppl 1):S10–S15

    Article  PubMed  Google Scholar 

  4. Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H (2014) Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 61:S45–S57

    Article  PubMed  Google Scholar 

  5. Razavi H, Elkhoury AC, Elbasha E et al (2013) Chronic hepatitis C virus (HCV) disease burden and cost in the United States. Hepatology 57:2164–2170

    Article  PubMed  PubMed Central  Google Scholar 

  6. Thiagarajan P, Ryder SD (2015) The hepatitis C revolution part 1: antiviral treatment options. Curr Opin Infect Dis 28:563–571

    Article  CAS  PubMed  Google Scholar 

  7. Kohli A, Shaffer A, Sherman A, Kottilil S (2014) Treatment of hepatitis C: a systematic review. JAMA 312:631–640

    Article  CAS  PubMed  Google Scholar 

  8. Suwanthawornkul T, Anothaisintawee T, Sobhonslidsuk A, Thakkinstian A, Teerawattananon Y (2015) Efficacy of second generation direct-acting antiviral agents for treatment naïve hepatitis C genotype 1: a systematic review and network meta-analysis. PLoS One 10:e0145953

    Article  PubMed  PubMed Central  Google Scholar 

  9. World Health Organization (WHO). An overview of the rationale, activities and goals of WHO-CHOICE: why is cost-effectiveness analysis important? Available online at: http://www.who.int/choice/description/importance/en/. Accessed 18 Nov 2016

  10. Hospital Authority of Hong Kong. Drug formulary management manual. Available online at: http://www.ha.org.hk/hadf/Portals/0/Docs/HADF_manual_Eng.pdf. Accessed 18 Nov 2016

  11. Kuwabara H, Westerhout K, Treur M, Cerri K, Mahlich J, Yatsuhashi H (2015) Cost-effectiveness analysis of simeprevir in combination with peginterferon and ribavirin for treatment-naïve chronic hepatitis C genotype 1 patients in Japan. J Med Econ 18:502–511

    Article  PubMed  Google Scholar 

  12. Pfeil AM, Reich O, Guerra IM et al (2015) Cost-effectiveness analysis of sofosbuvir compared to current standard treatment in Swiss patients with chronic hepatitis C. PLoS One 10:e0126984

    Article  PubMed  PubMed Central  Google Scholar 

  13. Saab S, Gordon SC, Park H, Sulkowski M, Ahmed A, Younossi Z (2014) Cost-effectiveness analysis of sofosbuvir plus peginterferon/ribavirin in the treatment of chronic hepatitis C virus genotype 1 infection. Aliment Pharmacol Ther 40:657–675

    Article  CAS  PubMed  Google Scholar 

  14. San Miguel R, Gimeno-Ballester V, Blázquez A, Mar J (2015) Cost-effectiveness analysis of sofosbuvir-based regimens for chronic hepatitis C. Gut 64:1277–1288

    Article  PubMed  Google Scholar 

  15. Younossi ZM, Park H, Saab S, Ahmed A, Dieterich D, Gordon SC (2015) Cost-effectiveness of all-oral ledipasvir/sofosbuvir regimens in patients with chronic hepatitis C virus genotype 1 infection. Aliment Pharmacol Ther 41:544–563

    Article  CAS  PubMed  Google Scholar 

  16. Bickerstaff C (2015) The cost-effectiveness of novel direct acting antiviral agent therapies for the treatment of chronic hepatitis C. Expert Rev Pharmacoecon Outcomes Res 15:787–800

    Article  PubMed  Google Scholar 

  17. Cure S, Guerra I, Cammà C, Craxì A, Carosi G (2015) Cost-effectiveness of sofosbuvir plus ribavirin with or without pegylated interferon for the treatment of chronic hepatitis C in Italy. J Med Econ 18:678–690

    Article  PubMed  Google Scholar 

  18. Rein DB, Wittenborn JS, Smith BD, Liffmann DK, Ward JW (2015) The cost-effectiveness, health benefits, and financial costs of new antiviral treatments for hepatitis C virus. Clin Infect Dis 61:157–168

    Article  PubMed  Google Scholar 

  19. Sullivan SD, Mauskopf JA, Augustovski F et al (2014) Budget impact analysis—principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health 17:5–14

    Article  PubMed  Google Scholar 

  20. American Association for the Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA) (2016) Recommendations for testing, managing, and treating hepatitis C. Available online at: http://hcvguidelines.org/sites/default/files/HCV-Guidance_July_2016_b.pdf. Accessed 6 Sep 2016

  21. O’Mahony JF, Newall AT, van Rosmalen J (2015) Dealing with time in health economic evaluation: methodological issues and recommendations for practice. Pharmacoeconomics 33:1255–1268

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhou DX, Tang JW, Chu IM et al (2006) Hepatitis C virus genotype distribution among intravenous drug user and the general population in Hong Kong. J Med Virol 78:574–581

    Article  CAS  PubMed  Google Scholar 

  23. Centre for Health Protection, Department of Health, The Government of the Hong Kong Special Administrative Region (2014) Surveillance of viral hepatitis in Hong Kong: 2014 update report. Available online at: http://www.chp.gov.hk/en/epidemiology/29/135/622/133.html. Accessed 8 Nov 2016

  24. Hassanein T, Shiffman ML, Zein NN (2007) The practical management of treatment failure in chronic hepatitis C: a summary of current research and management options for refractory patients. Gastroenterol Hepatol 3:4–32

    Google Scholar 

  25. The Hospital Authority (2013) Hospital authority ordinance (Chapter 113). Revisions to list of charges. Available online at: http://www.ha.org.hk/haho/ho/cs/207298en_txt.pdf. Accessed 8 Nov 2015

  26. Thorlund K, Druyts E, El Khoury AC, Mills EJ (2012) Budget impact analysis of boceprevir and telaprevir for the treatment of hepatitis C genotype 1 infection. Clinicoecon Outcomes Res 4:349–359

    PubMed  PubMed Central  Google Scholar 

  27. Lewis H, Cunningham M, Foster G (2012) Second generation direct antivirals and the way to interferon-free regimens in chronic HCV. Best Pract Res Clin Gastroenterol 26:471–485

    Article  CAS  PubMed  Google Scholar 

  28. Borba HH, Wiens A, Steimbach LM et al (2017) Network meta-analysis of first- and second-generation protease inhibitors for chronic hepatitis C genotype 1: efficacy based on RVR and SVR 24. Eur J Clin Pharmacol 73:1–14

    Article  CAS  PubMed  Google Scholar 

  29. Gohil K (2014) Huge growth seen in hepatitis C market. Pharm Ther 39:517

    Google Scholar 

  30. Westerhout K, Treur M, Mehnert A, Pascoe K, Ladha I, Belsey J (2015) A cost utility analysis of simeprevir used with peginterferon + ribavirin in the management of genotype 1 hepatitis C virus infection, from the perspective of the UK National Health Service. J Med Econ 18:838–849

    Article  PubMed  Google Scholar 

  31. Gimeno-Ballester V, Mar J, San Miguel R (2016) Cost-effectiveness analysis of simeprevir with daclatasvir for non-cirrhotic genotype-1b-naïve patients plus chronic hepatitis C. Expert Rev Pharmacoecon Outcomes Res 16:285–294

    Article  PubMed  Google Scholar 

  32. Najafzadeh M, Andersson K, Shrank WH et al (2015) Cost-effectiveness of novel regimens for the treatment of hepatitis C virus. Ann Intern Med 162:407–419

    Article  PubMed  Google Scholar 

  33. World Health Organization (WHO) (2016) Making choices in health: WHO guide to cost-effectiveness analysis. Available online at: http://www.who.int/choice/publications/p_2003_generalised_cea.pdf?ua=1. Accessed 11 Nov 2016

  34. Lyons MS, Kunnathur VA, Rouster SD et al (2016) Prevalence of diagnosed and undiagnosed hepatitis C in a midwestern urban emergency department. Clin Infect Dis 62:1066–1071

    Article  PubMed  PubMed Central  Google Scholar 

  35. Taylor LE, Foont JA, DeLong AK et al (2014) The spectrum of undiagnosed hepatitis C virus infection in a US HIV clinic. AIDS Patient Care STDs 28:4–9

    Article  PubMed  PubMed Central  Google Scholar 

  36. Scott JA (2014) The dangers of untreated hepatitis C. Available online at: http://www.everydayhealth.com/hs/hepatitis-c-living-well/dangers-untreated-hepatitis-c/. Accessed 22 Nov 2016

  37. LaFleur J, Hoop R, Morgan T et al (2014) High rates of early treatment discontinuation in hepatitis C-infected US veterans. BMC Res Notes 7:266

    Article  PubMed  PubMed Central  Google Scholar 

  38. Chen SL, Morgan TR (2006) The natural history of hepatitis C virus (HCV) infection. Int J Med Sci 3:47–52

    Article  PubMed  PubMed Central  Google Scholar 

  39. Marinho RT, Barreira DP (2013) Hepatitis C, stigma and cure. World J Gastroenterol 19:6703–6709

    Article  PubMed  PubMed Central  Google Scholar 

  40. van der Meer AJ, Veldt BJ, Feld JJ et al (2012) Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA 308:2584–2593

    Article  PubMed  Google Scholar 

  41. Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (2016) Health expenditure. Available online at: http://www.fhb.gov.hk/statistics/en/statistics/health_expenditure.htm. Accessed 18 Nov 2016

  42. The World Bank (2016) GDP (current US$). Available online at: http://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=HK. Accessed Nov 18 2016

  43. Andreone P, Colombo MG, Enejosa JV et al (2014) ABT-450, ritonavir, ombitasvir, and dasabuvir achieves 97% and 100% sustained virologic response with or without ribavirin in treatment-experienced patients with HCV genotype 1b infection. Gastroenterology 147:359–365.e1

    Article  CAS  PubMed  Google Scholar 

  44. Poordad F, Hezode C, Trinh R et al (2014) ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. N Engl J Med 370:1973–1982

    Article  PubMed  Google Scholar 

  45. Bacon BR, Gordon SC, Lawitz E et al (2011) Boceprevir for previously treated chronic HCV genotype 1 infection. N Engl J Med 364:1207–1217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Poordad F, McCone J Jr, Bacon BR et al (2011) Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med 364:1195–1206

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Afdhal N, Zeuzem S, Kwo P et al (2014) Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med 370:1889–1898

    Article  PubMed  Google Scholar 

  48. Feld JJ, Moreno C, Trinh R et al (2016) Sustained virologic response of 100% in HCV genotype 1b patients with cirrhosis receiving ombitasvir/paritaprevir/r and dasabuvir for 12 weeks. J Hepatol 64:301–307

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, 999077, China

    X. Li, N. S. Chan, A. W. Tam & E. W. Chan

  2. Division of Gastroenterology & Hepatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, 999077, China

    I. F. N. Hung

Authors
  1. X. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. S. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. W. Tam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. F. N. Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. W. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. W. Chan.

Ethics declarations

Funding

This work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

EWC has received financial support from Janssen, a division of Johnson & Johnson, Bristol Myers Squibb, Pfizer, and Eisai; The Pharmaceutical Society of Hong Kong; The University of Hong Kong; Early Career Scheme and the General Research Fund, Research Grants Council, Hong Kong, all unrelated to the current work. The other co-authors declare no conflict of interest.

Ethical approval and informed consent

The requirements for Institutional Review Board (IRB) approval and informed consent were waived as this was a pharmacoeconomic modeling study without patient contact.

Authorship contribution statement

Conception and design of the work: XL, NSC, IFNH, and EWC; data collection, analysis, and interpretation: XL and NSC; drafting the article: XL; critical revision of the article: XL, NSC, AWT, IFNH, and EWC; final approval of the version to be published: XL, NSC, AWT, IFNH, and EWC.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 105 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, X., Chan, N.S., Tam, A.W. et al. Budget impact and cost-effectiveness analyses of direct-acting antivirals for chronic hepatitis C virus infection in Hong Kong. Eur J Clin Microbiol Infect Dis 36, 1801–1809 (2017). https://doi.org/10.1007/s10096-017-2995-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-017-2995-7

Keywords

Search

Navigation