OBJECTIVES:

Colombia reported that 1.6% of all deaths between 1997-2020 may have been linked to Hepatitis C virus (HCV) infection. In order to inform decisions to improve HCV care, we developed a Markov model to estimate the cost-effectiveness of pan-genotypic DAA regimen (velpatasvir/sofosbuvir, SOF/VEL) for the treatment of Hepatitis C most used in Colombia, an upper-middle income country with a constrained healthcare budget.

METHODS:

All population ³40 years old in Colombia was included in the analysis. In the base case, 50% of the population is assumed to be screened for HCV (at a cost of CO$14,092,977). HCV + entering the model in one of the stages of fibrosis (F0-F4), and going through compartments of cirrhosis, liver cancer, liver transplant, and ultimately death for Hepatitis C. Patients can be recovered (in F0), and/or with virological sustained response (VSR) if in F0-F4 or with cirrhosis. Treatment coverage was set at 50%. Cost-effectiveness was measured as incremental cost/disability-adjusted life-years (cost/DALY).

RESULTS:

At base case, SOF/VEL would avoid 15% of cases of liver cancer (n=544) and 34% of deaths (n=1,209) caused by all Hepatitis C, with a reduction of 9,200 lost life-years. The incremental cost-effectiveness ratio (ICER) of SOF/VEL for the treatment of Hepatitis C in Colombia was CO$53 million/DALY. The ICER is reduced by increasing the treatment coverage, achieving CO$42 million/DALY if treatment coverage reach 100%.

CONCLUSIONS:

Pan-genotypic generic DAA regimens for treatment of HCV are available in several low-income/middle-income countries, important for treatment scale-up. In Colombia the regimen SOF/VEL for treatment of HCV is cost effective.