OBJECTIVES : he arise of direct-acting antivirals (DAAs) has dramatically improved the effectiveness and reduced adverse events, but they are expensive than traditional regimen at the same time. So our aim was to evaluate the cost-effectiveness of major DAA regimens compared with traditional regimen for chronic hepatitis C treatment-naive Chinese patients and to afford some references for decision-making in reimbursement system of China.

METHODS : A decision analytic Markov model was established to estimate the lifetime costs and outcomes from the perspective of the third-party payer. The data were obtained from clinical trials, literatures and drug price databases specific to China. The regimens compared include: a) pegylated interferon and ribavirin (PR); b) daclatasvir (DCV) and asunaprevir (ASV); c) sofosbuvir(SOF) and PR; d)ombitasvir, paritaprevir and ritonavir(OBV/PTV/r) and dasabuvir(DSV); e)elbasvir/ grazoprevir (EBR/ GZR). Sensitivity analyses were performed to evaluate model robustness.

RESULTS : Base-case analyses results show that in chronic hepatitis C treatment-naive Chinese patients, all those DAA regimens proved to be dominant over PR. DCV+ASV, SOF+PR, OBV/PTV/r+DSV and EBR/GZR gained 1.44,1.63,1.83 and 1.90 QALYs more than PR, respectively. The cost savings were RMB25366,16933,33897 and 38376, respectively. At the same time, DAA regimens prevented more long-term complications than PR. Probabilistic sensitivity analyses show that DCV+ASV, SOF+PR, OBV/PTV/r+DSV and EBR/ GZR had a probability of 80.70%, 77.50%, 84.80%, 86.60% probability of being cost-effective at WTP of one time GDP per capita when compared with PR, respectively.

CONCLUSIONS : DAA regimens are more cost-effective than PR, so traditional interferon therapy no longer has any advantage of price and efficacy. AS for the four DAA regimens considered in our research, EBR/ GZR was the most cost-effective. DAA regimens could be included in drug insurance list and case payment or value based payment for chronic hepatitis C treatment could be explored in the future.