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Value in Hepatitis C Virus Treatment: A Patient-Centered Cost-Effectiveness Analysis

Author

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  • T. Joseph Mattingly

    (University of Maryland School of Pharmacy)

  • Julia F. Slejko

    (University of Maryland School of Pharmacy)

  • Eberechukwu Onukwugha

    (University of Maryland School of Pharmacy)

  • Eleanor M. Perfetto

    (University of Maryland School of Pharmacy
    National Health Council)

  • Shyamasundaran Kottilil

    (University of Maryland School of Medicine)

  • C. Daniel Mullins

    (University of Maryland School of Pharmacy)

Abstract

Background Innovations in hepatitis C virus (HCV) therapy included in traditional comparative evaluations focus on sustained virologic response (SVR) without addressing challenges patients report beyond virologic cure. This study aims to evaluate the cost-effectiveness of HCV drug therapy with a patient-centered approach. Methods An individual-based Markov model was constructed using guidance from a stakeholder advisory board (SAB), a patient Delphi panel, and published literature to evaluate direct-acting antivirals (DAAs) compared to no treatment. The United States (US) health sector and societal perspectives were considered for 10- and 20-year time horizons. Inputs for treatment costs and effectiveness reflect a generic regimen. Indirect costs used for the societal model included estimates from self-reported productivity in a matched-control sample. Beyond the traditional quality-adjusted life-year (QALY) health outcome, this study included two novel measures developed from the Delphi panel and SAB: infected life-years and workdays missed. All costs were measured in 2018 US dollars. Results Health sector costs and QALYs were higher in the treatment group in both 10- and 20-year models. Total infected life-years and workdays missed were reduced in the treatment group for both models. When costs of absenteeism, presenteeism, and patient/caregiver time were included, the DAA intervention was cost-saving at both 10 and 20 years. Health sector results were sensitive to drug costs and utility estimates for post-SVR health states. Societal results were sensitive to presenteeism estimates and drug costs. Conclusion Treatment was cost-effective from a health sector perspective and cost-saving when including non-health costs such as patient/caregiver time and productivity.

Suggested Citation

  • T. Joseph Mattingly & Julia F. Slejko & Eberechukwu Onukwugha & Eleanor M. Perfetto & Shyamasundaran Kottilil & C. Daniel Mullins, 2020. "Value in Hepatitis C Virus Treatment: A Patient-Centered Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 38(2), pages 233-242, February.
    • Handle: RePEc:spr:pharme:v:38:y:2020:i:2:d:10.1007_s40273-019-00864-8
    DOI: 10.1007/s40273-019-00864-8
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    References listed on IDEAS

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    1. T. Joseph Mattingly & Julia F. Slejko & Eleanor M. Perfetto & Shyamasundaran Kottilil & C. Daniel Mullins, 2019. "What Matters Most for Treatment Decisions in Hepatitis C: Effectiveness, Costs, and Altruism," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 12(6), pages 631-638, December.
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    Cited by:

    1. T. Joseph Mattingly & Bryan L. Love & Bilal Khokhar, 2020. "Real World Cost-of-Illness Evidence in Hepatitis C Virus: A systematic review," PharmacoEconomics, Springer, vol. 38(9), pages 927-939, September.
    2. Susan dosReis & Beverly Butler & Juan Caicedo & Annie Kennedy & Yoon Duk Hong & Chengchen Zhang & Julia F. Slejko, 2020. "Stakeholder-Engaged Derivation of Patient-Informed Value Elements," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 13(5), pages 611-621, October.

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