Theme: Models of Care Year: 2019
Background: To determine the cost-effectiveness of treating hepatitis c virus (HCV) and the optimal
treating timing for genotype 1b treatment-naïve patients who inject drugs (PWID), under daclatasvir
(DCV) plus asunaprevir (ASV)and pegylated interferon plus ribavirin (PR) regimen, respectively.
Intervention: A decision analytical Markov model was conducted. Seven HCV treatment strategies
were compared: (i) no treatment; (ii) treat at fibrosis stages F3 (numerous septa without cirrhosis)
and F4 (compensated cirrhosis) using DCV +ASV regimen; (iii) treat all chronic patients using
DCV+ASV regimen; (iv) treat all patients including those at acute phase using DCV+ASV regimen; (v)
treat at fibrosis stages F3 and F4 using PR regimen; (vi) treat all chronic patients using PR regimen;
(vii) treat all patients using PR regimen. Costs included all direct medical costs from the societal
perspective, health-outcomes were measured using quality-adjusted life-years (QALYs). Incremental
cost-effectiveness ratios (ICERs) of treating F3 and F4 vs no treatment, treating all chronic vs treating
F3 and F4, and treating all patients vs treating chronic under DCV+ASV and PR regimen, were
analyzed.
Effectiveness: For DCV+ASV regimen, the corresponding ICER of treating F3 and F4 vs no treatment,
treating all chronic vs treating F3 and F4, and treating all patients vs treating chronic was US$-
1116.06/QALY, US$ 341.80/QALY and US$-35429.23/QALY, respectively. For PR regimen, the
corresponding ICER was US$-1671.44/QALY, US$1213.21/QALY and US$1492.01/QALY, respectively.
Probabilistic sensitivity analysis showed treating all patients using DCV+ASV regimen has a high
probability (99.8%) of being cost-effectiveness under a willingness-to-pay threshold of 1-time per
capita GDP (US $9765).
Conclusion and next steps: Earlier treatment for HCV is more cost-effective for genotype 1b PWID.
Future studies will continue to focus on other genotypes for clinical decision making.
Disclosure of Interest Statement:
This study was supported by the National Natural Science Foundation of China (NO.81473065). No
authors declare conflicts of interest.