Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study
Introduction Low-cost generic direct-acting antiviral (DAA) regimens for treatment of hepatitis C virus (HCV) are available in several low-income/middle-income countries, important for treatment scale-up. This study evaluated the cost-effectiveness of genotype-dependent and pan-genotypic DAA regimen...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-06-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e058757.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832584089348079616 |
|---|---|
| author | Seyed Moayed Alavian Mohammad Tasavon Gholamhoseini Heidar Sharafi Helena HL Borba Asma Sabermahani Behzad Hajarizadeh |
| author_facet | Seyed Moayed Alavian Mohammad Tasavon Gholamhoseini Heidar Sharafi Helena HL Borba Asma Sabermahani Behzad Hajarizadeh |
| author_sort | Seyed Moayed Alavian |
| collection | DOAJ |
| description | Introduction Low-cost generic direct-acting antiviral (DAA) regimens for treatment of hepatitis C virus (HCV) are available in several low-income/middle-income countries, important for treatment scale-up. This study evaluated the cost-effectiveness of genotype-dependent and pan-genotypic DAA regimens in Iran as an example of a resource-limited setting.Methods A Markov model was developed to simulate HCV natural history. A decision tree was developed for HCV treatment, assuming four scenarios, including scenario 1: genotyping, sofosbuvir/ledipasvir (SOF/LDV) for genotype 1, and sofosbuvir/daclatasvir (SOF/DCV) for genotype 3; scenario 2: genotyping, SOF/LDV for genotype 1, and sofosbuvir/velpatasvir (SOF/VEL) for genotype 3; scenario 3: no genotyping and SOF/DCV for all; and scenario 4: no genotyping and SOF/VEL for all. A 1-year cycle length was used to calculate the cumulative cost and effectiveness over a lifetime time horizon. We calculated quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) using a health system perspective. Costs were converted to US dollars using purchasing power parity exchange rate ($PPP). All costs and outcomes were discounted at an annual rate of 3%.Results Among people with no cirrhosis, scenario 3 had the minimum cost, compared with which scenario 4 was cost-effective with an ICER of 4583 $PPP per QALY (willingness-to-pay threshold: 9,311 $PPP per QALY). Among both people with compensated or decompensated cirrhosis, scenario 4 was cost saving. In sensitivity analysis, scenario 4 would be also cost-saving among people with no cirrhosis provided a 39% reduction in the cost of 12 weeks SOF/VEL.Conclusion Initiating all patients on pan-genotypic generic DAA regimens with no pretreatment genotyping was cost-effective compared with scenarios requiring pretreatment HCV genotype tests. Among generic pan-genotypic DAA regimens, SOF/VEL was cost-effective, for people with no cirrhosis and cost-saving for those with cirrhosis. |
| format | Article |
| id | doaj-art-b63067b4f98140f2ad32a158e9f3519f |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-b63067b4f98140f2ad32a158e9f3519f2025-01-27T18:05:09ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-058757Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness studySeyed Moayed Alavian0Mohammad Tasavon Gholamhoseini1Heidar Sharafi2Helena HL Borba3Asma Sabermahani4Behzad Hajarizadeh5Baqiyatallah Research Center for Gasteroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, Iran (the Islamic Republic of)Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranMiddle East Liver Diseases (MELD) Center, Tehran, IranDepartment of Pharmacy, Federal University of Parana, Curitiba, Parana, BrazilDepartment of Management, Health Policy and Health Economics, Kerman University of Medical Sciences, Kerman, IranThe Kirby Institute, University of New South Wales (UNSW Sydney), Sydney, New South Wales, AustraliaIntroduction Low-cost generic direct-acting antiviral (DAA) regimens for treatment of hepatitis C virus (HCV) are available in several low-income/middle-income countries, important for treatment scale-up. This study evaluated the cost-effectiveness of genotype-dependent and pan-genotypic DAA regimens in Iran as an example of a resource-limited setting.Methods A Markov model was developed to simulate HCV natural history. A decision tree was developed for HCV treatment, assuming four scenarios, including scenario 1: genotyping, sofosbuvir/ledipasvir (SOF/LDV) for genotype 1, and sofosbuvir/daclatasvir (SOF/DCV) for genotype 3; scenario 2: genotyping, SOF/LDV for genotype 1, and sofosbuvir/velpatasvir (SOF/VEL) for genotype 3; scenario 3: no genotyping and SOF/DCV for all; and scenario 4: no genotyping and SOF/VEL for all. A 1-year cycle length was used to calculate the cumulative cost and effectiveness over a lifetime time horizon. We calculated quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) using a health system perspective. Costs were converted to US dollars using purchasing power parity exchange rate ($PPP). All costs and outcomes were discounted at an annual rate of 3%.Results Among people with no cirrhosis, scenario 3 had the minimum cost, compared with which scenario 4 was cost-effective with an ICER of 4583 $PPP per QALY (willingness-to-pay threshold: 9,311 $PPP per QALY). Among both people with compensated or decompensated cirrhosis, scenario 4 was cost saving. In sensitivity analysis, scenario 4 would be also cost-saving among people with no cirrhosis provided a 39% reduction in the cost of 12 weeks SOF/VEL.Conclusion Initiating all patients on pan-genotypic generic DAA regimens with no pretreatment genotyping was cost-effective compared with scenarios requiring pretreatment HCV genotype tests. Among generic pan-genotypic DAA regimens, SOF/VEL was cost-effective, for people with no cirrhosis and cost-saving for those with cirrhosis.https://bmjopen.bmj.com/content/12/6/e058757.full |
| spellingShingle | Seyed Moayed Alavian Mohammad Tasavon Gholamhoseini Heidar Sharafi Helena HL Borba Asma Sabermahani Behzad Hajarizadeh Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study BMJ Open |
| title | Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study |
| title_full | Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study |
| title_fullStr | Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study |
| title_full_unstemmed | Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study |
| title_short | Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study |
| title_sort | economic evaluation of pan genotypic generic direct acting antiviral regimens for treatment of chronic hepatitis c in iran a cost effectiveness study |
| url | https://bmjopen.bmj.com/content/12/6/e058757.full |
| work_keys_str_mv | AT seyedmoayedalavian economicevaluationofpangenotypicgenericdirectactingantiviralregimensfortreatmentofchronichepatitisciniranacosteffectivenessstudy AT mohammadtasavongholamhoseini economicevaluationofpangenotypicgenericdirectactingantiviralregimensfortreatmentofchronichepatitisciniranacosteffectivenessstudy AT heidarsharafi economicevaluationofpangenotypicgenericdirectactingantiviralregimensfortreatmentofchronichepatitisciniranacosteffectivenessstudy AT helenahlborba economicevaluationofpangenotypicgenericdirectactingantiviralregimensfortreatmentofchronichepatitisciniranacosteffectivenessstudy AT asmasabermahani economicevaluationofpangenotypicgenericdirectactingantiviralregimensfortreatmentofchronichepatitisciniranacosteffectivenessstudy AT behzadhajarizadeh economicevaluationofpangenotypicgenericdirectactingantiviralregimensfortreatmentofchronichepatitisciniranacosteffectivenessstudy |