Generalized cost-effectiveness analysis to assess treatment value in hepatitis C

Area of Science:

• Health Economics
• Pharmacoeconomics
• Public Health

Background:

• Hepatitis C virus (HCV) poses a significant public health burden.
• Direct-acting antivirals (DAAs) offer a new treatment paradigm for HCV.
• Traditional cost-effectiveness analyses (CEAs) may not fully capture the value of DAAs.

Purpose of the Study:

• To estimate the comprehensive value of DAAs for HCV treatment compared to peginterferon alfa and ribavirin (PEG/riba).
• To employ a generalized cost-effectiveness analysis (GCEA) to assess societal-level value.
• To extend a Markov simulation model to include market dynamics and broader value elements.

Main Methods:

• A stepwise process was used to add novel value elements to a traditional CEA model.
• Incremental cost-effectiveness ratios (ICERs) were estimated for DAAs versus PEG/riba.
• A discrete-time Markov simulation model of HCV was extended to incorporate market dynamics and broader value.

Main Results:

• A traditional HTA-style CEA yielded an ICER of $64,512 per quality-adjusted life-year (QALY).
• Incorporating transmission dynamics, dynamic pricing, and efficacy reduced the ICER to $6406 per QALY.
• A fully realized GCEA, including genericization and productivity loss, further reduced the ICER to $4487 per QALY (a 93% reduction).

Conclusions:

• DAAs are a cost-effective treatment for HCV, even with conventional approaches.
• Incorporating broader value elements significantly improves the cost-effectiveness of DAAs.
• GCEAs are crucial for comprehensive decision-making in HCV treatment.