OBJECTIVES: Identification of costs associated with different DAAs regime through COI evaluation helps inform policy decisions and pharmacoeconomic analyses. This systematic literature review (SLR) aimed to identify real-world cost data related with HCV treatment.

METHODS: A literature search on Embase, and MEDLINE (Ovid) from January 2010 to May 2023 was conducted, to find cost related studies for DAAs against HCV infection published in English language and focusing India. Additional grey literature search included Google scholar and conference abstracts (AASLD, EASL, APASL, INASL). Retrieved studies were screened by two reviewers and conflicts resolved by third reviewer. Quality of included studies was assessed by using Drummond, New-Castle Ottawa Scale, and JBI checklists. Direct costs included costs on treatment, diagnosis, food, and accommodation. Indirect cost included loss of work and other intangible costs.

RESULTS:

A total of 146 studies were retrieved and 13 studies were extracted. Five studies were observational, six pharmacoeconomic analyses, and two database studies. Across studies, dialysis (52%) was common reason for infection, and GT-3 (45.2%-63.4%) was frequent genotype.

Mean drug cost/patient for 12 weeks with sofosbuvir+velpatasvir was INR43,447±21,247 in private and INR13,183±136 from state-government, with sofosbuvir+daclatasvir INR30,702±17,847 in private and INR4,019±849 from state-government, and with sofosbuvir+ledipasvir INR22,755±9,268 in private setting and INR9,576±0 from state-government. Mean diagnostic cost/patient was INR12,609±7,312 and INR2,687±16 in private and public setting, respectively. Overall, mean direct cost/patient with DAAs for 12 weeks was INR60,530±13,766 in private and INR27,119±17,304 in public setting. Mean indirect cost/patient was INR5,355±2,323 with HCV infection. No study for voxilaprevir and its combination was identified.

CONCLUSIONS: This SLR showed significant difference between market price (private) and state-government price for DAAs. High cost of DAAs is still a hinderance in HCV infection eradication. There was significant heterogeneity in costs among studies, so there is need to conduct more real-world studies on costs associated with HCV infection.