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Cost-effectiveness of daclatasvir plus asunaprevir for chronic hepatitis C genotype 1b treatment-naïve patients in China

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  • Yun Lu
  • Xiuze Jin
  • Cheng-a-xin Duan
  • Feng Chang

Abstract

Background: Hepatitis C is the second fastest growing infectious disease in China. The standard-of-care for chronic hepatitis C in China is Pegylated interferon plus ribavirin (PR), which is associated with tolerability and efficacy issues. An interferon- and ribavirin-free, all-oral regimen comprising daclatasvir (DCV) and asunaprevir (ASV), which displays higher efficacy and tolerability, has recently been approved in China. Objectives: This study is to estimate the cost-effectiveness of DCV+ASV (24 weeks) for chronic hepatitis C genotype 1b treatment-naïve patients compared with PR regimen (48 weeks) in China. Methods: A cohort-based Markov model was developed from Chinese payer perspective to project the lifetime outcomes of treating 10,000 patients with an average age of 44.5 with two hypothetical regimens, DCV+ASV and PR. Chinese-specific health state costs and efficacy data were used. The annual discount rate was 5%. Base-case analysis and sensitivity analysis were conducted. Results: For HCV Genotype 1b treatment-naïve patients, DCV+ASV proved to be dominant over PR, with a cost saving of ¥33,480(5,096 USD) and gains in QALYs and life years of 1.29 and 0.85, respectively. The lifetime risk of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver-related death was greatly reduced with DCV+ASV. Univariate sensitivity analysis demonstrated that key influencers were the discount rate, time horizon, initial disease severity and sustained virological response rate of DCV+ASV, with all scenarios resulting in additional benefit. Probabilistic sensitivity analysis demonstrated that DCV+ASV has a high likelihood (100%) of being cost-effective. Conclusion: DCV+ASV is not only an effective and well-tolerated regimen to treat chronic HCV genotype 1b infection treatment-naïve patients, but also is more cost-effective than PR regimen. DCV+ASV can benefit both the public health and reimbursement system in China.

Suggested Citation

  • Yun Lu & Xiuze Jin & Cheng-a-xin Duan & Feng Chang, 2018. "Cost-effectiveness of daclatasvir plus asunaprevir for chronic hepatitis C genotype 1b treatment-naïve patients in China," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-12, April.
    • Handle: RePEc:plo:pone00:0195117
    DOI: 10.1371/journal.pone.0195117
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    References listed on IDEAS

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    1. Phil McEwan & Ray Kim & Yong Yuan, 2013. "Assessing the Cost Utility of Response-Guided Therapy in Patients with Chronic Hepatitis C Genotype 1 in the UK Using the MONARCH Model," Applied Health Economics and Health Policy, Springer, vol. 11(1), pages 53-63, February.
    2. Guo-Feng Chen & Lai Wei & Jing Chen & Zhong-Ping Duan & Xiao-Guang Dou & Qing Xie & Wen-Hong Zhang & Lun-Gen Lu & Jian-Gao Fan & Jun Cheng & Gui-Qiang Wang & Hong Ren & Jiu-Ping Wang & Xing-Xiang Yang, 2016. "Will Sofosbuvir/Ledipasvir (Harvoni) Be Cost-Effective and Affordable for Chinese Patients Infected with Hepatitis C Virus? An Economic Analysis Using Real-World Data," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-13, June.
    3. Hai Chen & Lijun Chen, 2017. "Estimating cost-effectiveness associated with all-oral regimen for chronic hepatitis C in China," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-15, April.
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    1. Yin Liu & Xia Zou & Wen Chen & Cheng Gong & Li Ling, 2019. "Hepatitis C Virus Treatment Status and Barriers among Patients in Methadone Maintenance Treatment Clinics in Guangdong Province, China: A Cross-Sectional, Observational Study," IJERPH, MDPI, vol. 16(22), pages 1-15, November.

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