• Center on Health Equity and Access
  • Clinical
  • Health Care Cost
  • Health Care Delivery
  • Insurance
  • Policy
  • Technology
  • Value-Based Care

The Cost Debate on HCV Treatment in Europe

Article

While the cost of hepatitis C treatment continues to be a major topic of debate-with the approval of simeprevir (Olysio), sofosbuvir (Sovaldi), and now the combination, sofosbuvir and ledipasvir (Harvoni)-those in favor of the treatment provide a strong research-based argument. The cost-debate is global, as shown by this cost-effectiveness study conducted in Italy.

While the cost of hepatitis C treatment continues to be a major topic of debate—with the approval of simeprevir (Olysio), sofosbuvir (Sovaldi), and now the combination, sofosbuvir and ledipasvir (Harvoni)—those in favor of the treatment provide a strong research-based argument. In a recent issue of Evidence-Based Immunology and Infectious Disease, we heard both sides of the discussion.1,2 Disease complications—cirrhosis, end-stage liver disease, hepatocellular carcinoma, and liver transplantation—cost the US healthcare system approximately $6.5 billion annually, expected to touch $9.1 billion by 2024.3 At $1000 per dose, sofosbuvir alone will cost $84,000 for the typical 12 weeks of therapy in the United States, while its combination with ledipasvir is estimated at $94,500.1

The cost-debate is global, and a poster presented at The Liver Meeting 2014, an annual meeting organized by the American Association for the Study of Liver Disease, held in Boston, Massachusetts, from November 7 to 11, 2014. The multi-institute study by scientists in Italy, presented during the session Viral Hepatitis and Liver Transplant, assessed the cost-effectiveness of using sofosbuvir in combination with ribavirin (SOF/RBV)—a novel interferon-free treatment—to suppress HCV viremia in HCV patients listed for transplant, thereby preventing HCV recurrence. They evaluated the cost-effectiveness of SOF/RBV treatment in pre-transplant patients for cirrhosis (HCV-cirrhosis) or for hepatocellular carcinoma in cirrhosis (HCV-HCC), using a semi-Markov model. Comparing 2 different strategies—SOF/RBV for a maximum of 24 weeks or until an orthotopic liver transplant, if performed before the 24th week from treatment initiation versus no antiviral treatment—several different cost factors were considered, including life-years, quality-adjusted life years (QALY), and the incremental cost-effectiveness ratio (ICER) expressed as € per QALY gained.

In the base-case analysis, the authors estimated that the ICER for 24 weeks of SOF/RBVR was €30,518 per QALY gained in HCV-cirrhosis patients and €41,610 in HCV-HCC patients. They confirmed the results by the one way sensitivity-analysis and by the cost-effectiveness acceptability curve that reported 97.5% probability of SOF/RBV to be cost-effective at a willingness to pay threshold of €60,000 for HCV—cirrhosis, and 88.1% for HCV-HCC. SOF/RBV cost-effectiveness, say the authors, was clearly sensitive to the duration of treatment; assuming 12 weeks of SOF/RBV treatment duration, the ICER decreased to €19,317 in HCV-cirrhosis and €29,540 in HCV-HCC. They conclude that treating HCV-cirrhosis or HCV-HCC patients who are waiting for transplant, with SOF/RBV is cost-effective and may become the new standard of care for these patients. While pointing out the need for additional studies, they propose that direct-acting antivirals, currently under development in the transplant setting, could present additional opportunities.

References

  1. Thompson JR and Lee J. The price of progress in hepatitis C. Am J Manag Care. 2014;20(SP15):SP442-SP444.
  2. Younossi Z. Curing chronic hepatitis C with sofosbuvir-based regimens. Am J Manag Care. 2014;20(SP15):SP444-SP445.
  3. Razavi H, Elkhoury AC, Elbasha E, et al. Chronic hepatitis C virus (HCV) disease burden and cost in the United States. Hepatology 2013;57(6):2164-2170.
Related Videos
Shawn Kwatra, MD, dermatologist, John Hopkins University
Dr Laura Ferris Discusses Safety, Efficacy of JNJ-2113 in Patients with Plaque Psoriasis
dr krystyn van vliet
Martin Dahl, PhD, senior vice president, AnaptysBio
Jeff Stark, MD, vice president, head of medical immunology, UCB.
Jonathan Silverberg, MD, PhD, MPH, FAAD, professor of dermatology, director of clinical research and patch testing, George Washington University School of Medicine and Health Sciences
Monica Li, MD, University of British Columbia
Robert Sidbury, MD, MPH, FAAD, professor of pediatrics, division head of dermatology, Seattle Children's Hospital, University of Washington School of Medicine
Raj Chovatiya, MD, PhD, associate professor at the Rosalind Franklin University Chicago Medical School, founder and director of the Center for Medical Dermatology and Immunology Research
Related Content
© 2024 MJH Life Sciences
AJMC®
All rights reserved.