OBJECTIVES:

Following the long phase of interferon-based HCV treatment, direct-acting antiviral agents (DAAs) were developed. Availability of DAAs has changed the treatment landscape of hepatitis C virus (HCV) infection. However, access to DAAs is limited by their exceptionally high pricing, up to USD23,000 per 12-week course in Kazakhstan. The high price of DAAs has restricted their use in Kazakhstan. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective.

METHODS:

We constructed Markov models to compare the outcomes of no treatment versus treatment with DAAs for the HCV-infected population in Kazakhstan. Model parameters were estimated from from a systematic review of clinical trial results. Cost-effectiveness of HCV treatment using available DAAs was calculated, from a Kazakh payer perspective, assuming 3% annual discounting. The main outcome of the models was cost per quality-adjusted life-year (QALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted.

RESULTS:

The models indicated that, compared with with no treatment, the use of generic DAAs in Kazakh HCV patients would increase the life expectancy by 8.14 years, increase QALYs by 3.95, avert 19.01 DALYs, and reduce the lifetime healthcare costs by $2,100 per-person treated. Payback for the upfront costs of DAA drugs would be achieved in an overall average of less than 10 years - under 5 years for patients at advanced stages of HCV disease and almost 12 years if treatment begins at earlier stages. The results were robust to multiple sensitivity analyses.

CONCLUSIONS:

Treatment with generic DAAs available in Kazakhstan will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective.