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Cost-effectiveness and budgetary impact of HCV treatment with direct-acting antivirals in India including the risk of reinfection

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Listed:
  • Antoine Chaillon
  • Sanjay R Mehta
  • Martin Hoenigl
  • Sunil S Solomon
  • Peter Vickerman
  • Matthew Hickman
  • Britt Skaathun
  • Natasha K Martin

Abstract

Background: HCV direct-acting antivirals (DAAs) are produced in India at low cost. However, concerns surrounding reinfection and budgetary impact limit treatment scale-up in India. We evaluate the cost-effectiveness and budgetary impact of HCV treatment in India, including reinfection. Methods: A closed cohort Markov model of HCV disease progression, treatment, and reinfection was parameterized. We compared treatment by fibrosis stage (F2-F4 or F0-F4) to no treatment from a health care payer perspective. Costs (2017 USD$, based on India-specific data) and health utilities (in quality-adjusted life years, QALYs) were attached to each health state. We assumed DAAs with 90% sustained viral response at $900/treatment and 1%/year reinfection, varied in the sensitivity analysis from 0.1–15%. We deemed the intervention cost-effective if the incremental cost-effectiveness ratio (ICER) fell below India’s per capita GDP ($1,709). We assessed the budgetary impact of treating all diagnosed individuals. Results: HCV treatment for diagnosed F2-F4 individuals was cost-saving (net costs -$2,881 and net QALYs 3.18/person treated; negative ICER) compared to no treatment. HCV treatment remained cost-saving with reinfection rates of 15%/year. Treating all diagnosed individuals was likely cost-effective compared to delay until F2 (mean ICER $1,586/QALY gained, 67% of simulations falling under the $1,709 threshold) with 1%/year reinfection. For all scenarios, annual retesting for reinfection was more cost-effective than the current policy (one-time retest). Treating all diagnosed individuals and reinfections results in net costs of $445–1,334 million over 5 years (

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0217964
    DOI: 10.1371/journal.pone.0217964
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    References listed on IDEAS

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    1. 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.
    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.
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