OBJECTIVES:

Chronic Hepatitis C (CHC) is a costly disease to treat considering the development of the Direct Acting Antivirals (DAAs). In Saudi Arabia, economic changes require pharmacoeconomic evaluations to allocate resources properly. The research aimed to (1) estimate the total costs of hepatitis C treatment choices recommended by the Saudi Association for the Study of Liver Diseases and Transplantation (SASLT) based on data from the Saudi Food and Drug Authority (SFDA), (2) develop and operationalize the decision tree model and calculate the base-case incremental cost-effectiveness ratio (ICER), (3) perform deterministic and probabilistic sensitivity analyses testing the underlying assumptions in the decision tree model.

METHODS:

A cost-effectiveness analysis was performed on a hypothetical cohort comparing different chronic hepatitis C treatment strategies from the Saudi Food and Drug Authority’s (SFDA) perspective over a three-month period using a decision tree model. Data for this study were obtained retrospectively from the (SFDA) and published literature. Costs were measured in United States Dollars (USD). Life-years gained (Ly) were the outcomes measured in this study. Since the SASLT guidelines differ between genotype 1 and genotype 4, There were two separate decision tree models and analyses for each genotype cohort at a willingness to pay (WTP) of $65,000.

RESULTS:

In genotype 1 base-case analysis, the incremental cost-effectiveness comparison between the interventions showed that both Elbasvir/Grazoprevir and Paritaprevir/Ritonavir/ Ombitasvir plus Dasabuvir with Ribavirin dominated Sofosbuvir with Simeprevir and Ledipasvir/Sofosbuvir. Against Paritaprevir/Ritonavir/Ombitasvir plus Dasabuvir with Ribavirin, the ICER was $33,796/Ly for each additional cure. In genotype 4 base-case analysis, Paritaprevir/Ritonavir/Ombitasvir with Ribavirin dominated Sofosbuvir/ Ledipasvir and Sofosbuvir with Simeprevir.

CONCLUSIONS:

Except for Sofosbuvir with Simeprevir, the interventions compared in genotype 1 are competitive and cost effective while in genotype 4 Paritaprevir/Ritonavir/Ombitasvir with Ribavirin is highly recommended. Interventions in both genotypes will be dominated by Sofosbuvir low-priced generics with Simeprevir.