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

Applied Health Economics and Health Policy volume 19, pages 371–387 (2021)Cite this article

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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References

  1. World Health Organization. Hepatitis C[EB/OL]. https://www.who.int/zh/news-room/fact-sheets/detail/hepatitis-c.

  2. Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of hepatitis C (2019 version). Chin J Hepatol. 2019;35(12):2670–86.

    Google Scholar 

  3. Dhiman RK, Grover GS, Premkumar M. Hepatitis C elimination: a public health perspective. Curr Treat Options Gastroenterol. 2019;17(3):367–77.

    Article  Google Scholar 

  4. Chinese Bureau for disease control and prevention. General situation of legal infectious diseases in China [EB/OL]. https://www.nhc.gov.cn/jkj/s3578/new_list.shtml.

  5. Rao H, Wei L, Lopez-Talavera JC, et al. Distribution and clinical correlates of viral and host genotypes in Chinese patients with chronic hepatitis C virus infection. J Gastroenterol Hepatol. 2014;29(3):545–53.

    CAS  Article  Google Scholar 

  6. Chen Y, Yu C, Yin X, Guo X, Wu S, Hou J. Hepatitis C virus genotypes and subtypes circulating in Mainland China. Emerg Microbes Infect. 2017;6(11):e95.

    PubMed  PubMed Central  Google Scholar 

  7. Chen W, Ward T, Tan MP, Yan J, Wang PF, Wygant GD, Gordon J. Daclatasvir combined with asunaprevir is a cost-effective and cost-saving treatment for hepatitis C infection in China. J Compar Effectiv Res. 2018;20:20.

    Google Scholar 

  8. Liu Y, Zhang H, Zhang L, Zou X, Ling L. Economic evaluation of hepatitis C treatment extension to acute infection and early-stage fibrosis among patients who inject drugs in developing countries: a case of China. Int J Environ Res Public Health. 2020;17:3.

    Google Scholar 

  9. Liu Y, Wang Z, Tobe RG, Lin H, Wu B. Cost effectiveness of daclatasvir plus asunaprevir therapy for Chinese patients with chronic hepatitis C virus genotype 1b. Clin Drug Investig. 2018;38(5):427–37.

    Article  Google Scholar 

  10. Lu Y, Jin X, Chang F. Cost-effectiveness of daclatasvir plus asunaprevir for chronic hepatitis C genotype 1b treatment-naïve patients in China. PLoS One. 2018;13(4):e0195117.

    Article  Google Scholar 

  11. Zhou H, Lu Y, Wu B, Che D. Cost-effectiveness of oral regimens for adolescents with chronic hepatitis C virus infection. Pediatr Infect Dis J. 2020;39(6):e59–65.

    Article  Google Scholar 

  12. Wu B, Wang Z, Xie Q. Cost-effectiveness of novel regimens for Chinese patients with chronic hepatitis C. Curr Med Res Opin. 2018;20:1–21.

    Google Scholar 

  13. Chen P, Ma A, Liu Q. Cost-effectiveness of Elbasvir/Grazoprevir versus daclatasvir plus asunaprevir in patients with chronic hepatitis C virus genotype 1b Infection in China. Clin Drug Investig. 2018;38(11):1031–9.

    CAS  Article  Google Scholar 

  14. China Guidelines for Pharmacoeconomic Evaluations Research Group. China guidelines for pharmacoeconomic evaluations. China J Pharm Econ. 2011;03:6-9-11–48.

    Google Scholar 

  15. National Bureau of Statistics. National Data Inquiry System for GDP [EB/OL]. https://data.stats.gov.cn/easyquery.htm?cn=C01.

  16. Li JF, Liu S, Ren F, et al. Fibrosis progression in interferon treatment-naive Chinese plasma donors with chronic hepatitis C for 20 years: a cohort study. Int J Infect Dis. 2014;27:49–53.

    Article  Google Scholar 

  17. Rao HY, Li H, Chen H, et al. Real-world treatment patterns and clinical outcomes of HCV treatment-naive patients in China: an interim analysis from the CCgenos study. J Gastroenterol Hepatol. 2017;32(1):244–52.

    CAS  Article  Google Scholar 

  18. Corman S, Elbasha EH, Michalopoulos SN, Nwankwo C. Cost-utility of Elbasvir/Grazoprevir in patients with chronic hepatitis C genotype 1 infection. Value Health. 2017;20(8):1110–20.

    Article  Google Scholar 

  19. van der Meer AJ, Veldt BJ, Feld JJ, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308(24):2584–93.

    Article  Google Scholar 

  20. Morgan RL, Baack B, Smith BD, Yartel A, Pitasi M, Falck-Ytter Y. Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: a meta-analysis of observational studies. Ann Intern Med. 2013;158(5 Pt 1):329–37.

    Article  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. Fattovich G, Giustina G, Degos F, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology. 1997;112(2):463–72.

    CAS  Article  Google Scholar 

  23. Townsend R, McEwan P, Kim R, Yuan Y. Structural frameworks and key model parameters in cost-effectiveness analyses for current and future treatments of chronic hepatitis C. Value Health. 2011;14(8):1068–77.

    Article  Google Scholar 

  24. Warren E, Wright A, Jones B. Cost-effectiveness of telaprevir in patients with genotype 1 hepatitis C in Australia. Value Health. 2014;17(8):792–800.

    Article  Google Scholar 

  25. National Bureau of Statistics. National Data Inquiry System [EB/OL]. https://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm.

  26. El-Kamary SS, Jhaveri R, Shardell MD. All-cause, liver-related, and non-liver-related mortality among HCV-infected individuals in the general US population. Clin Infect Dis. 2011;53(2):150–7.

    Article  Google Scholar 

  27. Veldt BJ, Saracco G, Boyer N, et al. Long term clinical outcome of chronic hepatitis C patients with sustained virological response to interferon monotherapy. Gut. 2004;53(10):1504–8.

    CAS  Article  Google Scholar 

  28. Chen GF, Wei L, Chen J, et al. Will Sofosbuvir/Ledipasvir (Harvoni) be cost-effective and affordable for Chinese patients infected with hepatitis C virus? An economic analysis using real-world data. PLoS One. 2016;11(6):e0155934.

    Article  Google Scholar 

  29. Manos MM, Darbinian J, Rubin J, Ray GT, Shvachko V, Denis B, Velez F, Quesenberry C. The effect of hepatitis C treatment response on medical costs: a longitudinal analysis in an integrated care setting. J Manag Care Pharm. 2013;19(6):438–47.

    Article  Google Scholar 

  30. Wei L, Hu S, Hou J, Liu G, Ren H, Duan Z, Xie Q, Fang X, Jia J. A novel estimation of the impact of treatment with entecavir on long-term mortality, morbidity, and health care costs of chronic hepatitis B in China. Value Health Reg Issues. 2013;2(1):48–56.

    Article  Google Scholar 

  31. Thein HH, Krahn M, Kaldor JM, Dore GJ. Estimation of utilities for chronic hepatitis C from SF-36 scores. Am J Gastroenterol. 2005;100(3):643–51.

    Article  Google Scholar 

  32. Levy AR, Kowdley KV, Iloeje U, Tafesse E, Mukherjee J, Gish R, Bzowej N, Briggs AH. The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health. 2008;11(3):527–38.

    Article  Google Scholar 

  33. Younossi ZM, Stepanova M, Henry L, Nader F, Hunt S. An in-depth analysis of patient-reported outcomes in patients with chronic hepatitis C treated with different anti-viral regimens. Am J Gastroenterol. 2016;111(6):808–16.

    CAS  Article  Google Scholar 

  34. Tan YW, Tao Y, Liu LG, Ye Y, Zhou XB, Chen L, He C. Epidemiological features of chronic hepatitis C infection caused by remunerated blood donors: a nearly 27-year period survey. World J Gastroenterol. 2018;24(11):1250–8.

    Article  Google Scholar 

  35. Jia J, Wei L, Zhuang H. Recommendations on accelerating the review and registration of drugs for the eradication of hepatitis C and reducing prices. J Clin Hepatobil Dis. 2016;32(05):825.

    Google Scholar 

  36. Ruggeri M, Romano F, Basile M, Coretti S, Rolli FR, Drago C, Cicchetti A. Cost-Effectiveness analysis of early treatment of chronic HCV with Sofosbuvir/Velpatasvir in Italy. Appl Health Econ Health Policy. 2018;16(5):711–22.

    Article  Google Scholar 

  37. Goel A, Chen Q, Chhatwal J, Aggarwal R. Cost-effectiveness of generic pan-genotypic sofosbuvir/velpatasvir versus genotype-dependent direct-acting antivirals for hepatitis C treatment. J Gastroenterol Hepatol. 2018;33(12):2029–36.

    CAS  Article  Google Scholar 

  38. Page K, Osburn W, Evans J, et al. Frequent longitudinal sampling of hepatitis C virus infection in injection drug users reveals intermittently detectable viremia and reinfection. Clin Infect Dis. 2013;56(3):405–13.

    CAS  Article  Google Scholar 

  39. Scotto R, Buonomo AR, Moriello NS, Maraolo AE, Zappulo E, Pinchera B, Gentile I, Borgia G. Real-world efficacy and safety of pangenotypic direct-acting antivirals against hepatitis C virus infection. Rev Recent Clin Trials. 2019;14(3):173–82.

    CAS  Article  Google Scholar 

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Author notes

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

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

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  1. Pingyu Chen
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  2. Min Jin
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Correspondence to Hongchao Li.

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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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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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