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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

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



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.


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.


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.


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.


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


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