Hepatitis C disease transmission and treatment uptake: impact on the cost-effectiveness of new direct-acting antiviral therapies

Hayley Bennett (), Jason Gordon, Beverley Jones, Thomas Ward, Samantha Webster, Anupama Kalsekar, Yong Yuan, Michael Brenner and Phil McEwan
Additional contact information
Hayley Bennett: HEOR, Health Economics and Outcomes Research Ltd
Jason Gordon: HEOR, Health Economics and Outcomes Research Ltd
Beverley Jones: HEOR, Health Economics and Outcomes Research Ltd
Thomas Ward: HEOR, Health Economics and Outcomes Research Ltd
Samantha Webster: HEOR, Health Economics and Outcomes Research Ltd
Anupama Kalsekar: Bristol-Myers Squibb Pharmaceuticals Ltd
Yong Yuan: Bristol-Myers Squibb Pharmaceuticals Ltd
Michael Brenner: UK HEOR, Bristol-Myers Squibb Pharmaceuticals Ltd
Phil McEwan: HEOR, Health Economics and Outcomes Research Ltd

The European Journal of Health Economics, 2017, vol. 18, issue 8, No 6, 1011 pages

Abstract: Abstract Background Hepatitis C virus (HCV) treatment can reduce the incidence of future infections through removing opportunities for onward transmission. This benefit is not captured in conventional cost-effectiveness evaluations of treatment and is particularly relevant in patient groups with a high risk of transmission, such as those people who inject drugs (PWID), where the treatment rates have been historically low. This study aimed to quantify how reduced HCV transmission changes the cost-effectiveness of new direct-acting antiviral (DAA) regimens as a function of treatment uptake rates. Methods An established model of HCV disease transmission and progression was used to quantify the impact of treatment uptake (10–100%), within the PWID population, on the cost-effectiveness of a DAA regimen versus pre-DAA standard of care, conducted using daclatasvir plus sofosbuvir in the UK setting as an illustrative example. Results The consequences of reduced disease transmission due to treatment were associated with additional net monetary benefit of £24,304–£90,559 per patient treated at £20,000/QALY, when 10–100% of eligible patients receive treatment with 100% efficacy. Dependent on patient genotype, the cost-effectiveness of HCV treatment using daclatasvir plus sofosbuvir improved by 36–79% versus conventional analysis, at 10–100% treatment uptake in the PWID population. Conclusions The estimated cost-effectiveness of HCV treatment was shown to improve as more patients are treated, suggesting that the value of DAA regimens to the NHS could be enhanced by improved treatment uptake rates among PWID. However, the challenge for the future will lie in achieving increased rates of treatment uptake, particularly in the PWID population.

Keywords: Hepatitis C virus; Disease transmission; Cost-effectiveness; PWID (search for similar items in EconPapers)
JEL-codes: I1 (search for similar items in EconPapers)
Date: 2017
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DOI: 10.1007/s10198-016-0844-8

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