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Hepatol Res. 2016 Mar;46(5):423-33. doi: 10.1111/hepr.12570. Epub 2015 Oct 6.

Estimating the cost-effectiveness of daclatasvir plus asunaprevir in difficult to treat Japanese patients chronically infected with hepatitis C genotype 1b.

Author information

1
Health Economics and Outcomes Research, Monmouth, Wales, UK.
2
Center for Health Economics, Swansea University, Cardiff, Wales, UK.
3
World Wide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals, Princeton, New Jersey, USA.
4
Graduate School of Public Policy, The University of Tokyo, Tokyo, Japan.
5
Department of Hepatology, Toranomon Hospital, Tokyo, Japan.
6
Health Economics and Outcomes Research, Bristol-Myers K.K., Tokyo, Japan.

Abstract

AIM:

Standard of care for chronic hepatitis C in Japan is currently a pegylated interferon (IFN)-α + ribavirin (PR)-based regimen, notably associated with efficacy and tolerability issues. The advent of novel direct-acting antivirals (DAA) has provided more efficacious and better tolerated treatments. This study investigated the cost-effectiveness of the daclatasvir + asunaprevir (DCV + ASV) DAA regimen in patients infected with hepatitis C virus (HCV) genotype 1b who had previously not responded to or were ineligible for IFN-containing regimens.

METHODS:

A cost-utility analysis using an established Markov model compared DCV + ASV with simeprevir + PR (SMV + PR), telaprevir + PR (TVR + PR) and no treatment using Japanese-specific model inputs, with costs and utility values discounted at 2%. A cohort of patients was simulated until death and predicted quality-adjusted life-years (QALY) and costs were estimated. A subgroup analysis of patients with no DCV resistance was conducted.

RESULTS:

In all scenarios, DCV + ASV was predicted to be dominant over the comparator; namely, DCV + ASV was associated with increased QALY gains and decreased cost. In patients treated during the chronic hepatitis C stage, cost reductions were ¥1 057 288-2 619 206, and in patients treated during the compensated cirrhosis (CC) stage, reductions were ¥1 032 224-2 531 930. QALY gains were 0.749-2.609 and 0.874-3.043, respectively. Results improved when considering the subgroup of patients without DCV resistance.

CONCLUSION:

Cost-effectiveness conclusions are similar for patients treated in the chronic hepatitis C and CC disease stages, with DCV + ASV expected to be cost-saving versus standard of care in Japan for patients with HCV genotype 1b patients who have failed prior therapy or are IFN-ineligible/intolerant.

KEYWORDS:

chronic hepatitis C; cost-effectiveness analysis; daclatasvir; direct-acting antivirals

PMID:
26440999
DOI:
10.1111/hepr.12570

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