WILLINGNESS TO PAY FOR INNOVATIVE DRUGS- ANTI-HCV TREATMENT FROM THE ITALIAN NATIONAL HEALTH SYSTEM PERSPECTIVE

OBJECTIVES: A new scenario of therapy for HCV infection is being established with the approval. The aim of this study is to evaluate the long-term health outcomes and the willingness to pay of new anti-HCV treatment from the Italian societal perspective. METHODS: A multistate model was developed to estimate the HCV-infection process in a theoretical cohort. The Markov process considered 12 health states (F0, F1, F2, F3, Compensated cirrhosis (F4), SVR, decompensated cirrhosis, HCC, Transplantation (1 year), Transplantation (years later), HCV-related death and death from other causes) and 42 transition probabilities. The model was informed with available data published in national and international literature. Effectiveness of new treatment strategies was estimated from literature review. Cumulative cases of HCV-related diseases, direct and indirect medical costs, avoided by the increased effectiveness of new treatments, were estimated. RESULTS: The cohort of subjects with chronic HCV in 2013 amounts to 267.190 subjects, of these about 17,600 patients F3-F4 are treated with drug therapy. Cumulative cases of HCV-related diseases who succeed in preventing by the increased effectiveness of new treatments amounted to 47.433 after 7 years, 156.507 after 17 years, 256.942 after 27 years. The direct net medical costs, after the cost of the drug, amounted to € 18,13, € 72,33 and € 143,24 millions after 7, 17 and 27 years respectively, and € 166,51, € 950,3 and € 551,53 attributable to indirect costs avoided, for the same time horizons. Furthermore, it was estimated that each patient treated with new drugs achieves a reduction of expenditure of about € 12,000 in terms of direct costs, and € 4,000 in terms of indirect costs. CONCLUSIONS: In conclusion, an important share of the cost per treated patient can be compensated by the reduction of direct and indirect costs guaranteed by the effectiveness of new treatments.