DAAs Cost-effective in HCV Patients with Advanced Fibrosis

A modeling study compared health benefits and costs of all currently licensed treatments, both singly and in sequential therapy of up to 3 lines.

Sequential therapy with direct-acting antiviral agents (DAAs) is cost-effective in hepatitis C virus (HCV) patients with advanced fibrosis, according to a new study.

The new DAAs for HCV infection offer high cure rates, but they cost more than interferon-based treatments. From an economic perspective, the new DAAs are cost-effective if their health benefits exceed the opportunity cost, stated researchers led by Dr Rita Faria of the Centre for Health Economics at the University of York in York, United Kingdom.

The researchers published their results in August 2016 Alimentary Pharmacology & Therapeutics.

To identify cost-effective treatments for patients with HCV infection with F3 liver fibrosis who are at high risk of progression to cirrhosis, the researchers devised a decision-analytic model to compare the health benefits and costs of all currently licensed treatments as single treatments and in sequential therapy of up to three lines. Health benefits were expressed in quality-adjusted life years.

The goal of the study was to establish whether patients who are at high risk of progression to cirrhosis on the basis of having hepatic fibrosis at a significant stage should be treated before progressing to cirrhosis, and to assess how many lines of treatment and which of these treatments the patients should receive.

“Treatment before progression to cirrhosis always offers the most health benefits for the least costs,” the researchers stated. “Sequential therapy with multiple treatment lines cures over 89% of patients across all HCV genotypes while ensuring a cost-effective use of resources.”

Cost-effective regimens for HCV genotype 1 patients include first-line oral therapy with sofosbuvir–ledipasvir and second-line therapy with ombitasvir-paritaprevir-ritonavir plus dasabuvir with or without ribavirin.

Peginterferon still has a role to play in the management treatment-naïve patients with HCV genotypes 2, 3, and 4. In these patients, the new DAAs should be the second line of treatment for those who fail to achieve sustained virologic response (SVR) with pegylated interferon plus ribavirin or those who are intolerant to interferon-based therapy, they stated.

The researchers noted that it is unknown whether a third line of treatment should be offered or what it should be. “By this point, the most cost-effective treatment options have generally been utilized and the remaining options offer only marginal benefits. Furthermore, there is additional uncertainty in the SVR rates of treatments as the third line,” they stated.

In conclusion, the researchers stated: “These results are robust to a series of scenario analyses and are consistent with clinical guidelines which recommend that patients should be treated to avoid progression to cirrhosis.” They noted that questions still remain on the cost-effective treatment strategy in HCV-infected patients with milder liver disease.

The study shows that cost-effective treatment for HCV can be established using decision analytic modelling comparing single and sequential therapies. “This information is of significant benefit to health care providers with budget limitations and provides a sound scientific basis for drug treatment choices,” they stated, adding “given the large eligible population, the costs of implementing a cost-ineffective treatment strategy are high, with potentially adverse impacts on the health of other patients.”

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