Generic direct-acting antivirals for hepatitis C virus may not only be cost effective, but save money over 10 years compared with management of the virus, according to a recently published model.
“This is a win–win situation for the low- and low–middle-income countries where the generic DAAs can be sold. If these countries spend money on HCV treatment today, they will recoup it in the form of reduced health care expenditure within less than 1 decade,” Rakesh Aggarwal, MD, DM, from the Sanjay Gandhi Postgraduate Institute of Medical Sciences, India, said in a press release. “There is hardly any other health care intervention with such good return. Our results should show political leaders in those countries that they have a wonderful opportunity to make a difference for their constituents.”
Aggarwal and colleagues designed the MATCH-India model to simulate the cost-effectiveness and benefit of treating patients with HCV in India using generic DAAs compared with no treatment. The model was designed using parameters estimated from published studies. Thirty unique patient profiles were chosen with an average patient age of 35 years and HCV infection of either genotype 1, 3 or 4. The DAAs recorded in this study included generic varieties of sofosbuvir-ledipasvir (with or without ribavirin) and sofosbuvir-daclatasvir combination. The researchers ran 10,000 iterations for each profile.
Compared with no treatment, DAA treatment increased overall life expectancy by 8.02 years and discounted quality-adjusted life years by 3.89. Lifetime cost was estimated to be $1,988 per person in patients without treatment for management of HCV, compared with $679 per person in treated patients, including the cost of DAAs, pre- and posttreatment tests, and management.
The researchers also estimated that low-cost generic DAAs in India would avert 19.07 disability-adjusted life years per person. Compared with no treatment, treating 10,000 patients with the generic DAAs would prevent approximately 3,850 cases of decompensated cirrhosis, 2,500 cases of hepatocellular carcinoma and 4,550 liver-related deaths. In patients with cirrhosis, the estimation was approximately 3,400 decompensated cirrhosis cases, 1,800 HCC cases and 4,000 liver-related deaths prevented.
Cost-effectiveness was noted as early as 2 years after starting treatment and recognized at 10 years. “By 10 years, the upfront cost of DAAs had been offset by savings from prevention of decompensated cirrhosis and HCC, even if gains in life-years and [quality-adjusted life years] were ignored,” the researchers wrote. Cost-effectiveness was apparent sooner in cases of advanced disease, such as 4.72 years for patients with cirrhosis compared with 11.8 years for non-cirrhotic patients.
“In several low-income countries, DAAs are available at highly discounted prices. Our cost-effectiveness analysis showed that the treatment of HCV infection with DAAs at the prices prevalent in India was not only cost-effective, but was in fact cost-saving,” the researchers concluded. “Our results provide a compelling case for India to invest in HCV treatment.” – by Talitha Bennett
Aggarwal and colleagues report no relevant financial disclosures.