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Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India

Author

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  • Rakesh Aggarwal
  • Qiushi Chen
  • Amit Goel
  • Nicole Seguy
  • Razia Pendse
  • Turgay Ayer
  • Jagpreet Chhatwal

Abstract

Background & aims: Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective. Methods: A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs. Model parameters were estimated from published studies. Cost-effectiveness of HCV treatment using available DAAs was calculated, using a payer’s perspective. We estimated quality-adjusted life years (QALYs), disability-adjusted life years (DALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted. Results: Compared with no treatment, the use of generic DAAs in Indian HCV patients would increase the life expectancy by 8.02 years, increase QALYs by 3.89, avert 19.07 DALYs, and reduce the lifetime healthcare costs by $1,309 per-person treated. Treatment became cost-effective within 2 years, and cost-saving within 10 years of its initiation overall and within 5 years in persons with cirrhosis. Treating 10,000 HCV-infected persons could prevent 3400–3850 decompensated cirrhosis, 1800–2500 HCC, and 4000–4550 liver-related deaths. The results were sensitive to the costs of DAAs, pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response. Conclusions: Treatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective.

Suggested Citation

  • Rakesh Aggarwal & Qiushi Chen & Amit Goel & Nicole Seguy & Razia Pendse & Turgay Ayer & Jagpreet Chhatwal, 2017. "Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-15, May.
    • Handle: RePEc:plo:pone00:0176503
    DOI: 10.1371/journal.pone.0176503
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    References listed on IDEAS

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    1. Swathi Iyengar & Kiu Tay-Teo & Sabine Vogler & Peter Beyer & Stefan Wiktor & Kees de Joncheere & Suzanne Hill, 2016. "Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis," PLOS Medicine, Public Library of Science, vol. 13(5), pages 1-22, May.
    2. Jagpreet Chhatwal & Tianhua He & Maria A. Lopez-Olivo, 2016. "Systematic Review of Modelling Approaches for the Cost Effectiveness of Hepatitis C Treatment with Direct-Acting Antivirals," PharmacoEconomics, Springer, vol. 34(6), pages 551-567, June.
    3. Janel Hanmer & William F. Lawrence & John P. Anderson & Robert M. Kaplan & Dennis G. Fryback, 2006. "Report of Nationally Representative Values for the Noninstitutionalized US Adult Population for 7 Health-Related Quality-of-Life Scores," Medical Decision Making, , vol. 26(4), pages 391-400, July.
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    Cited by:

    1. Yashika Chugh & Radha Krishan Dhiman & Madhumita Premkumar & Shankar Prinja & Gagandeep Singh Grover & Pankaj Bahuguna, 2019. "Real-world cost-effectiveness of pan-genotypic Sofosbuvir-Velpatasvir combination versus genotype dependent directly acting anti-viral drugs for treatment of hepatitis C patients in the universal cove," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-24, August.
    2. Antoine Chaillon & Sanjay R Mehta & Martin Hoenigl & Sunil S Solomon & Peter Vickerman & Matthew Hickman & Britt Skaathun & Natasha K Martin, 2019. "Cost-effectiveness and budgetary impact of HCV treatment with direct-acting antivirals in India including the risk of reinfection," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-16, June.
    3. Waranya Rattanavipapong & Thunyarat Anothaisintawee & Yot Teerawattananon, 2018. "Revisiting policy on chronic HCV treatment under the Thai Universal Health Coverage: An economic evaluation and budget impact analysis," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-15, February.
    4. Anita W M Suijkerbuijk & Albert Jan van Hoek & Jelle Koopsen & Robert A de Man & Marie-Josee J Mangen & Hester E de Melker & Johan J Polder & G Ardine de Wit & Irene K Veldhuijzen, 2018. "Cost-effectiveness of screening for chronic hepatitis B and C among migrant populations in a low endemic country," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-16, November.

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