PIN26 Cost-minimization analysis of pan-genotypic treatment regimens for chronic hepatitis C
Gordon S, Smith N, and Dieterich D. PIN26 COST-MINIMIZATION ANALYSIS OF PAN-GENOTYPIC TREATMENT REGIMENS FOR CHRONIC HEPATITIS C. Value in Health 2019; 22:S198.
Value in Health
Objectives: Given the proposed goal of hepatitis C virus (HCV) elimination by 2030, the WHO treatment guidelines recommend first-line treatment of chronic hepatitis C (CHC) with pan-genotypic direct-acting antivirals (DAAs), such as sofosbuvir/velpatasvir (SOF/VEL) or glecaprevir/pibrentasvir (GLE/PIB). This study evaluated the relative economic impact of SOF/VEL Authorized Generic, relative to GLE/PIB, in CHC patients. Methods: A Markov model simulated outcomes of a cohort of 10,000 HCV genotype (GT) 1-6 non-cirrhotic (NC) and cirrhotic (CC) treatment-naïve patients with an average age of 52 years from a US third-party payer perspective over a lifetime horizon. Model inputs were extrapolated from clinical trials, published literature, or expert opinion. The model assumed 73.3% of patients were GT1; 13.1%, GT2; 12.1%, GT3; 1.3%, GT4; and, 0.1% GT5/6. 14.6% of GT1-2/4-6 patients were CC (20.4% for GT3). Costs included medical, pharmacy (based on Wholesale Acquisition Costs), and monitoring costs. Results: SOF/VEL resulted in a lifetime cost reduction of $3,933 per CHC patient as compared to GLE/PIB ($32,601 vs. $36,534 for SOF/VEL vs. GLE/PIB, respectively). This was principally driven by the reduced drug acquisition costs of SOF/VEL Authorized Generic. Cost-saving results were robust in one-way sensitivity analyses. Conclusions: Treating with SOF/VEL is a cost-saving strategy in the first-line treatment of CHC patients. Furthermore, given the simplicity of SOF/VEL as an oral single-tablet, pan-fibrotic, once-daily, protease-inhibitor free formulation with one regimen length for all genotypes, SOF/VEL may be the primary choice for achieving HCV elimination.