OBJECTIVES: In China, an estimated 9,795,000 people are chronically infected with hepatitis C virus (HCV), which can lead to life-threatening and resource-intensive complications. Current standard of care has suboptimal efficacy and safety; however, novel direct-acting antiviral (DAA) regimens have improved rates of sustained virologic response (SVR) and tolerability. This study aimed to assess the health economic outcomes of daclatasvir+asunaprevir (DUAL), the first DAA to be approved in China, versus current treatments for patients with HCV genotype 1b (an estimated 5,563,560 patients), from the Chinese payer perspective.

METHODS: A published HCV Markov model was used to perform lifetime cost-effectiveness analyses (CEA) of 24 weeks DUAL (SVR: 92.4%, discontinuation: 0.6%, regimen cost: ¥57,810RMB) versus 48 weeks pegylated interferon-alfa+ribavirin (PR, SVR: 62.4%, discontinuation: 3.9%, regimen cost: ¥53,977RMB) and 48 weeks interferon-alfa+ribavirin (IR, SVR: 43.0%, discontinuation: 19.0%, regimen cost: ¥45,016RMB). A budget impact model was developed to predict 2017/18 cost implications of introducing DUAL in China, applying forecast uptake rates and market share, assuming no discontinuation and that 35% of costs are covered by the patient. Published model inputs were specific to the Chinese setting and a 5% annual discounting rate applied.

RESULTS: The CEA demonstrated improvements in benefit associated with initiation of DUAL: incremental quality-adjusted life years of 1.29 and 2.10 and incremental life-years of 0.85 and 1.40 per patient, versus PR and IR, respectively, with lifetime per-patient cost savings of ¥29,638 and ¥37,472, respectively. Introducing DUAL treatment is expected to result in an additional 31,333 patients achieving SVR in 2017/18, with a net budget impact of ¥18.90 million in 2017 and -¥0.07 million in 2018.

CONCLUSIONS: Introducing DUAL treatment for HCV in China is predicted to offer significant health-related benefit and a reduction in total lifetime cost, whilst having minimal impact (approximately 0.001% of total Chinese reimbursement expenditure) on total 2017/18 budget.