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Economic Consequences of Investing in Anti-HCV Antiviral Treatment from the Italian NHS Perspective: A Real-World-Based Analysis of PITER Data


  • Andrea Marcellusi

    () (University of Rome “Tor Vergata”
    Kingston University London)

  • Raffaella Viti

    (University of Rome “Tor Vergata”)

  • Loreta A. Kondili

    (Istituto Superiore di Sanità)

  • Stefano Rosato

    (Istituto Superiore di Sanità)

  • Stefano Vella

    (Istituto Superiore di Sanità)

  • Francesco Saverio Mennini

    (University of Rome “Tor Vergata”
    Kingston University London)


Objective We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy. Methods A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered. Results The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal €25 million, €15 million, and €9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were €50.13 and €55.50 million for 1000 patients treated in 2016 and 2017, respectively. Conclusions This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV.

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  • Andrea Marcellusi & Raffaella Viti & Loreta A. Kondili & Stefano Rosato & Stefano Vella & Francesco Saverio Mennini, 2019. "Economic Consequences of Investing in Anti-HCV Antiviral Treatment from the Italian NHS Perspective: A Real-World-Based Analysis of PITER Data," PharmacoEconomics, Springer, vol. 37(2), pages 255-266, February.
  • Handle: RePEc:spr:pharme:v:37:y:2019:i:2:d:10.1007_s40273-018-0733-3
    DOI: 10.1007/s40273-018-0733-3

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    References listed on IDEAS

    1. Matteo Ruggeri & Federica Romano & Michele Basile & Silvia Coretti & Francesca Romana Rolli & Carlo Drago & Americo Cicchetti, 2018. "Cost-Effectiveness Analysis of Early Treatment of Chronic HCV with Sofosbuvir/Velpatasvir in Italy," Applied Health Economics and Health Policy, Springer, vol. 16(5), pages 711-722, October.
    2. Andrea Marcellusi & Raffaella Viti & Francesco Damele & Calogero Cammà & Gloria Taliani & Francesco Saverio Mennini, 2016. "Early treatment in HCV: is it a cost-effective option from the Italian perspective?," CEIS Research Paper 370, Tor Vergata University, CEIS, revised 23 Mar 2016.
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