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Systematic Review of Modelling Approaches for the Cost Effectiveness of Hepatitis C Treatment with Direct-Acting Antivirals

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Abstract

Background

New direct-acting antivirals (DAAs) are highly effective for hepatitis C virus (HCV) treatment. However, their prices have been widely debated. Decision-analytic models can project the long-term value of HCV treatment. Therefore, understanding of the methods used in these models and how they could influence results is important.

Objective

Our objective was to describe and systematically review the methodological approaches in published cost-effectiveness models of chronic HCV treatment with DAAs.

Data Sources

We searched several electronic databases, including Medline, Embase and EconLit, from 2011 to 2015.

Study Eligibility

Study selection was performed by two reviewers independently. We included any cost-effectiveness analysis comparing DAAs with the old standard of care for HCV treatment. We excluded non-English-language studies and studies not reporting quality-adjusted life-years.

Study Appraisal and Synthesis Method

One reviewer collected data and assessed the quality of reporting, using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Another reviewer crosschecked the abstracted information. The development methods of the included studies were synthetized on the basis of good modelling practice recommendations.

Results

Review of 304 citations revealed 36 cost-effectiveness analyses. The reporting quality scores of most articles were rated as acceptable, between 67 and 100 %. The majority of the studies were conducted in Europe (50 %), followed by the USA (44 %). Fifty-six percent of the 36 studies evaluated the cost effectiveness of HCV treatment in both treatment-naive and treatment-experienced patients, 97 % included genotype 1 patients and 53 % evaluated the cost effectiveness of second-generation or oral DAAs in comparison with the previous standard of care or other DAAs. Twenty-one models defined health states in terms of METAVIR fibrosis scores. Only one study used a discrete-event simulation approach, and the remainder used state-transition models. The time horizons varied; however, 89 % of studies used a lifetime horizon. One study was conducted from a societal perspective. Thirty-three percent of studies did not conduct any model validation. We also noted that none of the studies modelled HCV treatment as a prevention strategy, 86 % of models did not consider the possibility of re-infection with HCV after successful treatment, 97 % of studies did not consider indirect economic benefits resulting from HCV treatment and none of the studies evaluating oral DAAs used real-world data.

Limitations

The search was limited by date (from 1 January 2011 to 8 September 2015) and was also limited to English-language and published reports.

Conclusions

Most modelling studies used a similar modelling structure and could have underestimated the value of HCV treatment. Future modelling efforts should consider the benefits of HCV treatment in preventing transmission, extra-hepatic and indirect economic benefits of HCV treatment, real-world cost-effectiveness analysis and cost effectiveness of HCV treatment in low- and middle-income countries.

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Acknowledgments

The authors thank Greg Pratt, DDS, MLS, for his help in creating the search strategy.

Author contributions

Jagpreet Chhatwal had full access to all of the data in the study and takes responsibility for the integrity and the accuracy of the data analysis.

Design and conduct of the study: Jagpreet Chhatwal, Tianhua He, Maria Lopez-Olivo.

Collection, management, analysis and interpretation of the data: Jagpreet Chhatwal, Tianhua He, Maria Lopez-Olivo.

Preparation, review or approval of the manuscript: Jagpreet Chhatwal, Tianhua He, Maria Lopez-Olivo.

Administrative, technical or material support: Jagpreet Chhatwal, Maria Lopez-Olivo.

Study supervision: Jagpreet Chhatwal.

Conflicts of interest

Jagpreet Chhatwal has received consulting fees from Merck, Gilead and Complete HEOR Solutions outside the scope of this work. Maria Lopez-Olivo has received consulting fees from Complete HEOR Solutions outside the scope of this work. Tianhua He has no conflicts of interest to report.

Author information

Authors and Affiliations

  1. Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac Street, 10th Floor, Boston, MA, 02114, USA

    Jagpreet Chhatwal

  2. Tsinghua University School of Medicine, Beijing, China

    Tianhua He

  3. Department of General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Maria A. Lopez-Olivo

Authors
  1. Jagpreet Chhatwal
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Corresponding author

Correspondence to Jagpreet Chhatwal.

Appendix: Medline search strategy [database(s): Ovid Medline® in-process and other non-indexed citations, and Ovid Medline®; searched on 9 Sep 2015]

Appendix: Medline search strategy [database(s): Ovid Medline® in-process and other non-indexed citations, and Ovid Medline®; searched on 9 Sep 2015]

#

Search

1

exp HEPATITIS C/

2

exp HEPACIVIRUS/

3

((hepatitis adj3 “C”) or hepacivir* or HCV).ti,ab

4

or/1–3

5

(telaprevir* or Incivek*).mp

6

(boceprevir* or Victrelis*).mp

7

(simeprevir* or Olysio* or TMC-435* or TMC435* or TMC-435350* or TMC435350*).mp

8

(paritaprevir* or Veruprevir*).mp

9

(asunaprevir* or BMS-650032* or BMS650032*).mp

10

(ledipasvir* or GS-5885* or GS5885*).mp

11

(ombitasvir* or ABT-267* or ABT267*).mp

12

(sofosbuvir* or Sovaldi* or GS-7977* or GS7977* or PSI-7977* or PSI7977*).mp

13

(dasabuvir* or ABT-333* or ABT333*).mp

14

(daclatasvir* or Daklinza*).mp

15

exp PROTEASE INHIBITORS/

16

(protease* adj3 inhibit*).mp

17

(direct* adj3 (anti-viral* or antiviral*)).mp

18

exp ANTIVIRAL AGENTS/and (direct* adj3 (act or acting)).ti,ab

19

or/5–18

20

4 and 19

21

limit 20 to English language

22

limit 21 to yr=“2011 -Current”

23

limit 22 to “review”

24

22 not 23

25

exp HEPATITIS C/ec

26

exp ANTIVIRAL AGENTS/ec

27

exp PROTEASE INHIBITORS/ec

28

exp MODELS, ECONOMIC/

29

exp ECONOMICS/

30

(cost or costs or costing or economi* or budget* or financ* or pharmacoeconom* or pharmacoeconom* or price* or pricing or expenditure* or affordab* or fee or fees or charg* or monetar*).ti,hw,kw

31

(economic* adj2 (burden* or barrier* or restriction* or resources)).ab

32

((cost or costs) adj3 (utilit* or effectiv* or benefit* or minimiz* or minimis* or model*)).ab

33

((decision* or cost*) adj3 (model* or analy*)).ti,ab,sh

34

or/25–33

35

24 and 34

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Chhatwal, J., He, T. & Lopez-Olivo, M.A. Systematic Review of Modelling Approaches for the Cost Effectiveness of Hepatitis C Treatment with Direct-Acting Antivirals. PharmacoEconomics 34, 551–567 (2016). https://doi.org/10.1007/s40273-015-0373-9

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