OBJECTIVES

: Cost-effectiveness evaluations for hepatitis C virus (HCV) treatments have been published frequently with the development of as new treatment modalities over the past decade. Our primary aim was to evaluate how the cost-effectiveness of first-line treatments have evolved over time compared to no treatment.

METHODS

: A health state transition model was used to calculate cost-effectiveness of first-line treatment regimens for HCV in 2010, 2012, 2014, 2016, and 2018 compared to no treatment over a 20-year time horizon from the payer perspective in 2018 US dollars. Expected drug costs and treatment effectiveness estimates for sustained virologic response (SVR) were calculated using the preferred regimen for each of the 6 HCV genotypes at each time point and the distribution of genotypes in the US population. Patients entered the model with different stages of liver fibrosis based on US estimates. Natural disease progression, post-SVR progression, and advanced fibrosis progression for re-infected patients were incorporated into the model. Utility estimates for each health state were used to calculate quality-adjusted life-years (QALYs) earned at each cycle.

RESULTS

: In the base case, no HCV treatment resulted in a gain of 11.54 QALYs over a 20-year time horizon at a cost of $42,938. Costs for the treated groups were $69,075, $123,267, $125,431, $86,782, and $56,470 for the 2010, 2012, 2014, 2016, and 2018 scenarios respectively. QALYs gained for the treated groups were 12.90, 12.97, 13.34, 13.39, and 13.46 for the 2010, 2012, 2014, 2016, and 2018 scenarios respectively. The incremental cost-effectiveness ratios in each year compared with no treatment were $19,218/QALY, $56,104/QALY, $45,829/QALY, $23,699/QALY, and $7,048/QALY.

CONCLUSIONS

: Over this time, treatment effectiveness has increased steadily while treatment costs increased substantially from 2010-2014 before decreasing to its lowest point in 2018. This study demonstrates the dynamic nature of cost-effectiveness analyses in a disease state with rapid pharmaceutical innovation.