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Economically Efficient Hepatitis C Virus Treatment Prioritization Improves Health Outcomes

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  • Lauren E. Cipriano
  • Shan Liu
  • Kaspar S. Shahzada
  • Mark Holodniy
  • Jeremy D. Goldhaber-Fiebert

Abstract

Background . The total cost of treating the 3 million Americans chronically infected with hepatitis C virus (HCV) represents a substantial affordability challenge requiring treatment prioritization. This study compares the health and economic outcomes of alternative treatment prioritization schedules. Methods . We developed a multiyear HCV treatment budget allocation model to evaluate the tradeoffs of 7 prioritization strategies. We used optimization to identify the priority schedule that maximizes population net monetary benefit (NMB). We compared prioritization schedules in terms of the number of individuals treated, the number of individuals who progress to end-stage liver disease (ESLD), and population total quality-adjusted life years (QALYs). We applied the model to the population of treatment-naive patients with a total annual HCV treatment budget of US$8.6 billion. Results . First-come, first-served (FCFS) treats the fewest people with advanced fibrosis, prevents the fewest cases of ESLD, and gains the fewest QALYs. A schedule developed from optimizing population NMB prioritizes treatment in the first year to patients with moderate to severe fibrosis who are younger than 65 years, followed by older individuals with moderate to severe fibrosis. While this strategy yields the greatest population QALYs, prioritization by disease severity alone prevents more cases of ESLD. Sensitivity analysis indicated that the differences between prioritization schedules are greater when the budget is smaller. A 10% annual treatment price reduction enabled treatment 1 year sooner to several patient subgroups, specifically older patients and those with less severe liver fibrosis. Conclusion . In the absence of a sufficient budget to treat all patients, explicit prioritization targeting younger people with more severe disease first provides the greatest health benefits. We provide our spreadsheet model so that decision makers can compare health tradeoffs of different budget levels and various prioritization strategies with inputs tailored to their population.

Suggested Citation

  • Lauren E. Cipriano & Shan Liu & Kaspar S. Shahzada & Mark Holodniy & Jeremy D. Goldhaber-Fiebert, 2018. "Economically Efficient Hepatitis C Virus Treatment Prioritization Improves Health Outcomes," Medical Decision Making, , vol. 38(7), pages 849-865, October.
    • Handle: RePEc:sae:medema:v:38:y:2018:i:7:p:849-865
    DOI: 10.1177/0272989X18792284
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    References listed on IDEAS

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    1. repec:nbr:nberch:13665 is not listed on IDEAS
    2. 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.
    3. Shan Liu & Lauren E Cipriano & Mark Holodniy & Jeremy D Goldhaber-Fiebert, 2013. "Cost-Effectiveness Analysis of Risk-Factor Guided and Birth-Cohort Screening for Chronic Hepatitis C Infection in the United States," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-14, March.
    4. Zaric, G.S. & Barnett, P.G. & Brandeau, M.L., 2000. "HIV transmission and the cost-effectiveness of methadone maintenance," American Journal of Public Health, American Public Health Association, vol. 90(7), pages 1100-1111.
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