OBJECTIVES : The aim of this analysis is to assess whether including human immunodeficiency virus (HIV) coinfected patients plays a role in reimbursement decisions for hepatitis C virus (HCV) treatments for adult patients in Scotland, the United Kingdom (UK), Canada, Australia, France, and Germany.

METHODS : The analysis used Scottish Medicines Consortium (SMC), National Institute for Health and Care Excellence (NICE), Canadian Agency for Drugs and Technologies in Health (CADTH), Pharmaceutical Benefits Advisory Committee (PBAC), Haute Autorité de Santé (HAS), and Gemeinsamer Bundesausschuss (G-BA) reimbursement decision data between 2009 and 2018. Non-submissions, differed, and no decisions were excluded. Statistical analyses were performed.

RESULTS : A total of 288 reimbursement decisions were included in the model of which, 84.72% (n=244) were positive. Out of all the agencies, G-BA gave the highest positive decisions, followed by HAS, with corresponding rates of 100% (n=70) and 97.6% (n=40), respectively. Among all the HCV therapies HAS approved for reimbursement, 95.12% (n=39) gave substantial improvement of which, all (n=2) treated HIV-coinfected patients. Conversely, the distribution of G-BA’s benefit scores was sporadic: 83% (n=6) of HCV therapies with HIV coinfection provided either a minor or unquantifiable benefit over comparators versus 35.72% (n=25) of all positive decisions combined. Approximately 45.71% (n=32) of HCV treatments and 16.67% (n=1) of HCV therapies for HIV-coinfected patients provided no additional benefit. HCV treatments for patients with HIV coinfection accounted for 4.51% (n=11) of positive decisions whereas HCV therapies alone constituted 95.49% (n=233) of the recommendations. Fisher’s exact test demonstrated that there is no significant relationship between receiving positive reimbursement decisions and submissions for HCV therapies for adult patients who have HIV coinfection (p=0.1558).

CONCLUSIONS : All HCV therapies for patients coinfected with HIV were recommended. However, due to the small number of decisions for this population, it's unclear whether including an HIV-coinfected subgroup increases the rate of receiving positive decisions.