OBJECTIVES: Hepatitis C virus (HCV) is a blood borne virus that can infect the liver, causing cirrhosis and decompensation of the liver, and hepatocellular carcinoma, requiring liver transplantation. A new class of oral medicines, called direct-acting antivirals (DAAs), have been developed to treat HCV, with cure rates observed in over 95% of patients treated for 12 weeks. DAAs are expensive; 12 weeks of therapy costs approximately £15,000 per patient. Shortened treatment durations, which have lower cure rates, have been proposed to reduce costs. We evaluate the lifetime cost-effectiveness of short-course first-line and re-treatment DAA regimens for treatment of non-cirrhotic HCV in genotype 1 patients.

METHODS: Assuming a UK National Health Service perspective, we use a decision tree and Markov model to compare eight, six, and four weeks of shortened treatment regimens against a standard 12-week treatment regimen; patients for whom shortened treatment is unsuccessful are retreated with a standard 12-week treatment regimen. Evidence on efficacy of treatment and retreatment, drug and healthcare costs and utilities are taken from a review of the literature.

RESULTS: Shortening treatment to eight weeks, with a cure rate of 88%, saves £4,899.57 per 1,000 patients and generates the same quality adjusted-life years (QALYs) as the standard 12-week treatment regimen. Treating patients for six weeks, with a cure rate of 63%, saves £2,549.08 but results in a QALY loss of 0.04 due to greater numbers developing advanced liver disease. Shortening treatment to four weeks, with a 33% cure rate, costs an additional £3,597.41 and results in a QALY loss of 0.11.

CONCLUSIONS: Treating patients for eight weeks is the dominant strategy, generating considerable cost-savings with no effect on QALYs. The results are sensitive to patient heterogeneity, namely patient’s baseline viral load. Future research should identify patients for whom shortened treatment duration is likely to be effective.