METHODS: : This study was conducted from the payer's perspective to evaluate the cost-effectiveness of using novel Direct Acting Antiviral agents in two treatment strategies, early treatment (initiated at fibrosis stages F2/F1/F0) versus delayed treatment (till fibrosis stages F3/F4). The model followed a typical patient’s QALY at each stage and throughout the progression of the disease as reported in the literature. Direct medical cost were identified, measured and valued from third party payers in Lebanon and based on patient case scenario from medical center. Incremental cost effectiveness analysis was then conducted measuring the incremental cost per QALYs gained and per life year extended.

RESULTS: The initiating of novel treatment soon after early stage diagnosis have led to an incremental cost effectiveness analysis (ICER) of 587 Euros per QALY gained. On the other hand, when outcomes of such treatment were measured over just the one-year duration when patient would receive treatment right after early stage diagnosed instead of delaying treatment until an advanced stage, the ICER was 27,268 Euros per QALY gained. In addition, when extended life year was used as the outcomes, the analysis showed that early treatment is associated with 1,527 Euros per additional life year extended. The one-way Sensitivity Analysis showed that a 25% decrease in the cost of dual drug option or if triple drug option was used, the ICER would significantly decrease to 16,982 Euros per QALY gained when treatment is initiated at early stage.

CONCLUSIONS: : ‘Earlier treatment’ is cost effective compared to ‘delayed treatment’ and thus reinforce the need to screen for HCV at early age so that initiation of therapy could be done as soon as confirming diagnosis.