OBJECTIVES : The introduction of direct-acting antivirals for chronic hepatitis C virus (HCV) infection management added significant value to Healthcare Systems and patients. Because of this, World Health Organization (WHO) proposed to HCV elimination, a worldwide public health problem, by 2030. The aim of this study was to evaluate the efficiency of Sofosbuvir(SOF)-based regimens during 2015-2019 in HCV patients compared to previous therapeutic strategies in Spain.

METHODS : A previously validated and published lifetime Markov model was used to simulate the disease progression of HCV patients. The same parameters considered in that model were used for this analysis: transition probabilities between health states, utilities, healthcare costs related to liver complications management and those associated with previous therapeutic strategies. In Spain, a total of 85,959 HCV patients were treated with SOF-based regimens during 2015-2019 and were considered as the target population (100% treated with SOF-based regimens vs. 38% with previous therapeutic strategies). Sustained Virological Responses and average drugs costs of SOF-based regimens were obtained from real-world data. From the Spanish National Health System (NHS) perspective, value was measured as clinical and economic impact in terms of avoided liver complications and mortality, total costs and quality-adjusted life years (QALYs); an annual 3% discount rate for cost and outcomes was applied.

RESULTS : Compared to previous therapeutic strategies, SOF-based regimens reduced 14,372 cases of decompensated cirrhosis (-89%), 9,473 hepatocellular carcinoma (-77%) and 1,878 liver transplants (-84%), decreasing the cost associated to the management of these liver complications in €770 million. SOF-based regimens also reduced liver-related mortality by 82% (-15,810). Besides, SOF-based regimens gained 310,765/QALYs, saving €274 million, considering drugs, monitoring, and disease management.

CONCLUSIONS : SOF-based regimens achieve significant clinical outcomes maximizing the value for HCV patients and contributing to the WHO goal, while decreasing the economic disease burden and generating significant savings to the Spanish NHS.