OBJECTIVES : We estimate the economic impact of DAA treatments on the future burden of hepatitis C, we created a Markov model of chronically HCV infected patients in four European countries: England, Italy, Romania and Spain.

METHODS : A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed comparing the efficacy of treatment according to the prioritization schemes followed for administration of DAA treatments between 2015 and 2018. Data stratifications for the disease states, genotypes and ages of DAA-treated patients were retrieved from real world data sources at national level. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the NHS investment in DAA treatment. To estimate the uncertainty of the economic results a deterministic sensitivity analysis (DSA) was performed.

RESULTS : In 2015/16 the number of avoided HCV-related cases in Italy was 1136 patients; 1310 in Romania; 1040 in Spain and 1134 in England respectively. In the subsequent period (2017/18), our model estimated 565 and 908 avoided cases in Italy and Romania compared to 505 and 546 in Spain and England respectively. The potential clinical outcomes reduction on time estimated for patients treated in 2015/16 and 2017/18 reflect important cost savings over 20 years period of time (-€ 52 million in Italy, -€ 57 million in Romania, -194 million in Spain and a reduction of 48 million in England). BPTs were 5.6 years in Italy, 6.5 in Romania, 4.6 in Spain and 7.5 in England respectively.

CONCLUSIONS : In all countries, the model estimated an increase in the number of avoided cases between the two periods of analysis and substantial cost savings over 20 years period of time. Therefore the results of this study may be a useful tool for public decision makers at European level.