A comparison of cost-effectiveness analysis of two strategies - immediate and delayed initiation of treatment of hepatitis C in the Czech Republic
Abstract
Background: Direct-acting antiviral agents (DAAs) dramatically improve the prognosis of patients with hepatitis C infection (HCV); however, high costs are limiting their wider usage. The aim of the present analysis was to compare the cost-effectiveness of treating treatment-naive patients with HCV genotype 1 (GT1) when treatment was initiated immediately with that of patients in whom treatment was delayed until the advanced liver fibrosis stage.
Materials and methods: A health-economic model with a typical structure for HCV infections was adapted to the Czech setting. A cohort of 10,000 patients entered the model and were treated with ledipasvir/sofosbuvir immediately (assessed cohort) or after they had reached the advanced fibrosis stage (comparative cohort).
Age and METAVIR distributions reflected those of the Czech Republic. Healthcare costs were considered as the base-case and healthcare and societal costs as the alternative scenario.
Efficacy, progression probabilities, and quality of life data were derived from the literature. Outcomes are presented as incremental cost-effectiveness ratios (ICERs) per QALY (Quality adjusted life-years).
Sensitivity analyses were performed to limit uncertainty. Results: In a life-time horizon, the immediate DAA treatment, regardless of disease stage, was dominant (less costly and more effective) compared to delayed treatment.
Dominance was seen if only healthcare costs were considered (ICER/QALY -4,414 CZK) as well as when healthcare and societal costs were taken into account (ICER/QALY -214,948 CZK). Immediate treatment prevented 619 events, mainly hepatocellular carcinoma and premature death.
Sensitivity analyses confirmed the robustness of the base case results. Conclusion: A cost-utility analysis is provided, which shows that immediate treatment of newly-diagnosed HCV GT1 patients is dominant in comparison with delayed treatment at the advanced fibrosis stage in a Czech setting.
Results are consistent if only direct or healthcare and societal costs are applied.