For individuals infected with hepatitis C virus (HCV), new regimens are highly effective, but also very expensive, at approximately $28,000 for 4 weeks of treatment. However, the treatment is cost effective for HCV patients with cirrhosis and for those without cirrhosis who have failed other treatments, according to a new study.
In an analysis of the cost effectiveness of sofosbuvir-based treatments for patients with HCV genotypes 2 and 3, Dr. Benjamin Linas of Boston Medical Center reported that when compared with pegylated interferon and ribavirin therapy, treatment regimens based on the new direct-acting antiviral are only cost effective for select groups (Ann. Intern Med, [doi:10.7326/M15-0674]).
Cure rates with sofosbuvir are higher than are rates with the previous standard of care, and sustained virologic response (SVR) “is associated with a greatly reduced lifetime risk for liver-related morbidity and mortality,” noted Dr. Linas and his colleagues.
Using sophisticated statistical modeling to compare HCV treatment with pegylated interferon and ribavirin – the previous standard of care – to the newly Food and Drug Administration–approved sofosbuvir-ribavirin regimen, Dr. Linas explored clinical outcomes and costs for several different patient groups, including treatment-naive and treatment-experienced HCV genotype 2 and 3 patients with and without cirrhosis.
Clinical outcomes, modeled from clinical trial and observational cohort data, were expressed as life expectancy in quality-adjusted life-years (QALYs) and lifetime medical costs. Investigators then calculated the incremental cost-effectiveness ratio (ICER) for each treatment strategy, dividing any additional cost for a more expensive treatment by the QALYs gained from this regimen.
Using the commonly accepted ICER threshold of $100,000 per QALY, Dr. Linas and colleagues concluded that sofosbuvir-based HCV therapy for treatment-naive patients without cirrhosis was not cost effective, with ICERs of $238,000-$266,000. Interferon-based treatments, they noted, still achieve an approximately 80% rate of cure in this population.
In the constrained resources of the real world, Dr. Linas and his associates noted that this analysis is important. “Treatment strategies that do not use limited resources where they are likely to have the greatest impact may result in unequal access to interferon-free regimens, thereby limiting the population-level benefits of new HCV treatments,” they said.