OBJECTIVES: New Direct Acting Antivirals (DAA) constituted a breakthrough innovation in chronic hepatitis C (CHC) treatments. Sustain virological response rates (>90% vs 54% à 70% previously) allowed cure in shorter treatment times with a fewer adverse events (AE) compared to treatment available prior to 2014. Studies have assessed and demonstrated cost-effectiveness of new DAAs. With an estimated 72,000 patients treated in France from 2014 to 2018, this study assessed the economic impact of DAA launch.

METHODS: A budget impact (BI) model was constructed to estimate the BI of CHC between 2014 and 2018 and to extrapolate long-term (up to 40y) direct and indirect costs for treated CHC patients. Extrapolation was based on a Markov model that simulated the natural history of CHC. Real-world data was used for treatment patterns and patients’ characteristics. Prices included published rebates, taxes. The model compared the real-world scenario (DAA) to a hypothetical scenario (no-DAA) where treatment patterns prior to 2014 were used for 2014-2018. No-DAA included lower number of treated patients and use of pegylated interferon, ribavirin, boceprevir and telaprevir only. Results compared direct costs (treatments, AEs, complications [HCC, decompensation, transplantation]) and indirect costs (loss of productivity) for both scenarios.

RESULTS: Only 30,000 patients would have been treated without DAA between 2014 and 2018 compared to 72,000 with DAA with a respective treatment cost of 0.7 billion euros (B€) vs 2.7. Long-term extrapolation shows an estimated 1.8 vs 0.8 B€ spending in other direct costs, and 3.4 vs 1.3 in indirect costs for no-DAA compared to DAA; total cost was estimated to 6.0 vs 4.8 B€, over a billion saving for DAA.

CONCLUSIONS: These results support that treating patients with DAAs allowed to save over a billion euros from a lifetime of 40 years and was a good investment from a collective perspective and individual benefice.