Value of Triage Treatment Strategies to Distribute Hepatitis C Direct-Acting Antiviral Agents in an Integrated Healthcare System: A Cost-Effectiveness Analysis |
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| Affiliation: | 1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;2. The Reagan-Udall Foundation for the Food and Drug Administration, Washington, DC, USA;3. Research Data Analytics, Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA;4. Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA;5. The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA;1. Erasmus School of Health Policy and Management, Department of Health Care Governance, Rotterdam, The Netherlands;2. Dutch Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands;1. Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany;2. Faculty of Business Administration and Economics/CINCH Health Economics Research Center, Universität Duisburg-Essen, Duisburg, Germany;1. Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada;2. Respiratory Evaluation Sciences Program, The University of British Columbia, Vancouver, BC, Canada;3. School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada;4. British Columbia Centre for Disease Control, Vancouver, BC, Canada;1. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia;2. National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia;3. Nepean Cancer Care Centre, Nepean Hospital, Kingswood, NSW, Australia;1. Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy;2. Multiple Sclerosis Centre, Spedali Civili di Brescia, Montichiari, Italy;3. IRCCS Multimedica, Sesto San Giovanni, Italy;4. Department of Medical, Surgical Science and Advanced Technology “GF Ingrassia,” University of Catania, Catania, Italy |
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| Abstract: | ObjectivesThis study aimed to assess the cost-effectiveness of fibrosis-based direct-acting antiviral treatment policies for patients with chronic hepatitis C virus at the Kaiser Permanente Mid-Atlantic States health system.MethodsWe used a Markov model to compare the lifetime costs and effects of treating patients with chronic hepatitis C virus at different stages of disease severity, or all stages simultaneously, based on a fibrosis score from the US healthcare sector perspective and societal perspective. The initial distribution of patients across fibrosis scores, the effectiveness of direct-acting antiviral therapy, and follow-up and monitoring protocols were specific to the Kaiser Permanente Mid-Atlantic States health system. Direct and indirect costs, transition probabilities, and utilities were derived from the literature. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results.ResultsThe “Treat All” option was dominant from both the societal and healthcare sector perspectives. The conclusion was robust in deterministic sensitivity analysis. The range of incremental costs between the less restrictive policies was small—the difference between the “Treat F1+” and the “Treat All” option was only $111 per person. Probabilistic sensitivity analyses showed, at both the $100 000/quality-adjusted life-year and $150 000/quality-adjusted life-year thresholds, there was a 70% chance that the “Treat All” option was more cost-effective than the “Treat F1+” option.ConclusionsWe found that expanded treatment access is cost-effective and, in many cases, cost saving. Although our results are primarily applicable to a regional integrated healthcare system, it offers some direction to any healthcare setting faced with resource constraints in the face of highly priced drugs. |
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| Keywords: | cost-effectiveness analysis hepatitis c virus antiviral |
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