OBJECTIVES : Several studies have investigated the cost-effectiveness of the new direct acting antiviral (DAA) hepatitis C treatments from the perspective of healthcare, however their effect on wider societal costs remain relatively unexplored. This study utilized real-world data to examine differences in work absence between newer and older treatment regimens.

METHODS : In this retrospective registry-based study three cohorts of patients treated in the county of Stockholm, Sweden were identified based on the national prescribed drug register and the national quality registry for hepatitis C: Cohort one consisted of patients treated with ribavirin and/or peginterferons during 2005-2011, cohort two of patients treated with the first generation of DAAs (telaprevir and boceprevir) during 2011-2013 and cohort 3 of patients treated with the new generation of DAAs 2014-2018. Based on matched data from the national social insurance agency (Försäkringskassan), the number of days with early retirement and sick leave during the year preceding treatment was compared with the following year. A difference-in-difference model was estimated to test for differences between the cohorts adjusting for age and gender.

RESULTS : The three cohorts consisted of 1,511, 199 and 2,303 patients respectively. The number of days away from work prior to treatment initiation was similar: 106, 85 and 94 days in cohort one, two and three. After treatment initiation the number of days away from worked increased in cohort one and two, to 150 and 140 days while it remained similar in cohort three (88 days). The increase was driven by an increase in sick-leave, while early retirement remained unchanged. The difference-in-difference model confirmed these results.

CONCLUSIONS : Fewer days off work was observed for patients undergoing treatment with the newer antiretroviral drugs, potentially driven by a more beneficial side effect profile. This is an important aspect to consider when considering the value of these drugs.