Estimating the Net Value of Treating Hepatitis C Virus Using a Newly Available Direct-Acting Antiviral in India

Background: Recently developed direct-acting antiviral (DAA) treatments for HCV have been groundbreaking for their high efficacy across disease genotypes and lack of severe side effects. This study uses a cost-of-illness (COI) approach to estimate the net value conferred by one of these novel drug combinations, sofosbuvir and velpatasvir (SOF/VEL), recently licensed for generic manufacture in India. Methodology: This study considers COI from lifetime earnings lost due to disability and premature death from HCV infection. Risk of death and disability in future years is calculated using a Markov state-transition model with parameters determined from the literature. The future earnings of sampled patients are predicted using an empirical earnings model with coefficients determined from India Human Development Survey data. Costs to both the patient and secondarily infected individuals are considered. Results: Curing individuals diagnosed with chronic HCV in India would preserve 36,83,290 INR in earnings per person. For non-cirrhotic (NC) and compensated cirrhotic (CC) individuals, the expected benefits associated with prevented secondary infections are worth between 1% and 40% of the value of benefits conferred to the diagnosed individual (depending on sex and extent of liver damage). Treating decompensated cirrhotic (DC) individuals with DAAs alone offers minimal earnings benefits because these individuals will likely remain disabled and unable to work without liver transplantation. Expected net benefits of treatment are substantial for NC and CC patients (ranging from 5,98,003 INR for NC women to 1,05,25,504 INR for CC men). The cost of treatment for DC individuals exceeds the expected earnings benefits. Conclusion: For average NC and CC individuals, the benefits of increased future productivity far outweigh the cost of treatment with SOF/VEL. Increased earnings are not sufficient to fully offset cost of treatment for DC individuals but treatment may still be justified on the basis of the intrinsic value of health improvements and other treatment benefits.