OBJECTIVES: To assess incremental cost per quality adjusted life year (QALYS) gained with use of pan-genotypic sofosbuvir + velpatasvir (SOF+VEL) for HCV patients, as compared to current regimen under universal free treatment scheme in Punjab, India.

METHODS: A Markov model depicting natural history of HCV was developed to simulate progression. Three scenarios were compared: I (Current) - using sofosbuvir + daclatasvir for non-cirrhotic patients and ledipasvir or daclatasvir according to genotype for cirrhotic patients; II – using SOF + DCV for non-cirrhotic patients and SOF+VEL for cirrhotic patients and III - using SOF+VEL for all. The lifetime costs, life-years and QALYs were assessed, using societal perspective. All future costs and health outcomes were discounted @ 3%. Finally, incremental cost per QALY gained was computed for scenario II and III, compared to I. Lifetime costs and QALYs were calculated for all scenarios against counterfactual of ‘no-universal free treatment scheme’.

RESULTS: Each of scenarios I, II and III dominate over no-universal free treatment scenario. Use of SOF+VEL only for cirrhotic patients (scenario II) increases QALYs by 0.28 (0.03-0.71) per person, and decreases cost by US$ 85 (US $ 17-202) per patient, when compared to scenario I. Compared to scenario I, scenario III leads to increase in QALYs by 0.44 (0.14-1.01) per person, and is cost-neutral where mean cost difference between scenario III and I is – US$ 38 per patient but it ranges from a cost-saving of US$ 212 to incurring an extra cost of US$ 49 per patient. Shift to scenario II and III increases the program budget by 5.5% and 60% respectively.

CONCLUSIONS: Overall, the use of velpatasvir is highly recommended for the treatment of HCV infection. In budget constraint settings, velpatasvir should be given to cirrhotic patients. However, if no budget constraint, universal use of velpatasvir for HCV treatment is recommended.