Cost-effectiveness and budgetary impact of HCV treatment with direct-acting antivirals in India including the risk of reinfection

Antoine Chaillon, Sanjay R Mehta, Martin Hoenigl, Sunil S Solomon, Peter Vickerman, Matthew Hickman, Britt Skaathun and Natasha K Martin

PLOS ONE, 2019, vol. 14, issue 6, 1-16

Abstract: Background: HCV direct-acting antivirals (DAAs) are produced in India at low cost. However, concerns surrounding reinfection and budgetary impact limit treatment scale-up in India. We evaluate the cost-effectiveness and budgetary impact of HCV treatment in India, including reinfection. Methods: A closed cohort Markov model of HCV disease progression, treatment, and reinfection was parameterized. We compared treatment by fibrosis stage (F2-F4 or F0-F4) to no treatment from a health care payer perspective. Costs (2017 USD$, based on India-specific data) and health utilities (in quality-adjusted life years, QALYs) were attached to each health state. We assumed DAAs with 90% sustained viral response at $900/treatment and 1%/year reinfection, varied in the sensitivity analysis from 0.1–15%. We deemed the intervention cost-effective if the incremental cost-effectiveness ratio (ICER) fell below India’s per capita GDP ($1,709). We assessed the budgetary impact of treating all diagnosed individuals. Results: HCV treatment for diagnosed F2-F4 individuals was cost-saving (net costs -$2,881 and net QALYs 3.18/person treated; negative ICER) compared to no treatment. HCV treatment remained cost-saving with reinfection rates of 15%/year. Treating all diagnosed individuals was likely cost-effective compared to delay until F2 (mean ICER $1,586/QALY gained, 67% of simulations falling under the $1,709 threshold) with 1%/year reinfection. For all scenarios, annual retesting for reinfection was more cost-effective than the current policy (one-time retest). Treating all diagnosed individuals and reinfections results in net costs of $445–1,334 million over 5 years (

Date: 2019
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0217964

DOI: 10.1371/journal.pone.0217964

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