OBJECTIVES: To review the economic modeling methods and cost-effectiveness of direct-acting antiviral agents (DAAs) for the treatment of chronic hepatitis C virus (HCV) infection.

METHODS: A systematic literature search was performed in February 2017 using Scopus and OVID to review relevant publications between 2011 to present. Two independent reviewers screened potential papers.

RESULTS: The database search resulted in a total of 1,536 articles; after deduplication, title/abstract and full text screening 67 studies were included for qualitative analysis. The vast majority of studies were conducted in high income countries (n=59), and used Markov-based modeling technique (n=60). Most of the analyses utilized long-term time horizons; 58 studies calculated lifetime costs and outcomes. The examined treatments were heterogenic among the studies; 7 analyses did not directly evaluated DAA treatments (along with screening or genotype testing). The examined treatments (n=60) were either dominant (23%), or cost-effective at base case (57%) or in given subgroups (18%). Only one (2%) study reported that the assessed DAA treatment is not cost-effective with the given setting and price.

CONCLUSIONS: Despite their high initial therapeutic costs, DAAs were found to be cost-effective to treat chronic HCV infection. Both public health and economic impact of DAAs are emergent in lower income countries; however, studies were predominantly conducted in higher income countries where it is easier to prove the cost-effectiveness of innovative medicines. The majority of publications only included list prices. Due to the confidentiality of actual pharmaceutical prices (which also applies to the comparator), the real incremental cost-effectiveness ratios may differ from the published values, and transferability of conclusions to other countries is highly limited. In conclusion, the value based price of DAAs has to be calculated in each country based on local economic evaluations.