A Cost-Effectiveness Analysis of Shortened Direct-Acting Antiviral Treatment in Genotype 1 Noncirrhotic Treatment-Naive Patients With Chronic Hepatitis C Virus

Christopher Fawsitt*, Peter Vickerman, Graham S Cooke, Nicky Welton, STOP-HCV Consortium

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

3 Citations (Scopus)
9 Downloads (Pure)

Abstract

Objectives: Direct-acting antivirals (DAAs) are successful in curing hepatitis C virus (HCV) in over 95% of patients treated for 12 weeks. DAAs are expensive, and shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. We evaluated the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 non-cirrhotic treatment-naïve patients.

Methods: Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare three unstratified shortened treatment durations (eight, six, and four weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were retreated with a 12-week treatment regimen. Parameter inputs were taken from published studies.

Results: Eight weeks treatment duration had an expected incremental net monetary benefit (INMB) of £7,737 (95% CI £3,242 to £11,819) versus standard 12 weeks treatment, per 1,000 patients. Six weeks treatment had a positive INMB, although some uncertainty was observed. The probability that eight and six weeks treatment was most cost-effective was 56% and 25%, respectively, while four weeks treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed eight weeks treatment was most cost-effective at all drug prices below £40,000 per 12-week course.

Conclusions: Shortening treatments licensed for 12 weeks to eight weeks is cost-effective in genotype 1 non-cirrhotic treatment-naïve patients. There was considerable uncertainty in the estimates for six and four weeks treatment, with some indication that six weeks treatment may be cost-effective.
Original languageEnglish
Pages (from-to)693-703
Number of pages11
JournalValue in Health
Volume22
Issue number6
Early online date17 May 2019
DOIs
Publication statusPublished - 1 Jun 2019

Keywords

  • cost effectiveness
  • direct-acting antivirals
  • hepatitis C virus
  • shortened treatment duration

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