OBJECTIVES : The study aims to evaluate the cost-effectiveness of standard of care (SOC), Daclatasvir in combination with Asunaprevir therapy and other direct acting antiviral agent regimens for the treatment of chronic hepatitis c patients in China.

METHODS : A Markov model was performed based on a payer perspective to estimate costs and quality-adjusted life years (QALYs) between interferon-alfa + ribavirin (IFN+RBV), pegylated interferon-alfa-2a + ribavirin (PegIFN+RBV), DUAL and Sofosbuvir/Ledipasvir (SOF/LDV) for HCV patients in China. Six health states were set according to natural history, including healed, chronic hepatitis C, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death. Health-state transition probabilities, sustained virological responses, and utility values were retrieved from Chinese-specific clinical trials and published literature. Treatment and disease management costs, life expectancy, quality-adjusted life years (QALYs) and cost-effectiveness were measured. Direct medical costs were included and obtained from published articles and Chinese standard cost list. The incremental cost-effectiveness ratio (ICER) was presented as costs per QALY gained. All costs, life years and QALYs were discounted by 3.5% per year.

RESULTS : In treatment-naïve patients, DUAL drug costs was USD8,353 (RMB54,293), higher than IFN+RBV(USD1,403) and PegIFN+RBV regimen(USD6,890), but lower than SOF/LDV(USD44,524). DUAL was associated with 2.71-4.16 QALYs gained and 0.83-1.32 incremental life-years per patient versus SOC, with discounted lifetime cost savings of USD7,393-7,491 per patient. For interferon-ineligible/intolerant patients, DUAL drug costs was USD8,368, lower than SOF/LDV. DUAL disease management costs was USD4,396, lower than IFN+RBV(USD18,740) and PegIFN+RBV regimen(USD13,350), higher than SOF/LDV(USD2,360). Results were robust across univariate and probabilistic sensitivity analyses.

CONCLUSIONS : It is demonstrated that treatment with DUAL provides significant clinical benefit, whilst accruing lower lifetime costs, due to improved rates of sustained virologic response over SOC.