OBJECTIVES: In 2015, local data showed that sofosbuvir is a cost-saving intervention compared to peg-interferon and ribavirin (PR). Due to its high budget impact, sofosbuvir was just recently introduced as a standard treatment under the Thai UHC in February 2018. This study was conducted to assess the economic impact of delayed access to sofosbuvir-based regimen from a health insurance payer perspective.

METHODS: A model-based economic evaluation approach was used to estimate the economic impact of delayed access to sofosbuvir-based regimen (scenario 1) compare to introduction of a sofosbuvir-based regimen in 2015 (scenario 2). Costs were estimated as direct medical costs including drug costs for HCV infection treatment and direct medical costs for HCV-related complications. We considered three hypothetical cohorts of patients with chronic HCV infection who could have accessed to sofosbuvir and followed them in the model for 30 years. All costs were discounted at 3%.

RESULTS: In scenario 1, PR was a drug of choice and total costs of PR would be $134,450,156. If sofosbuvir was adopted in 2015, drug costs for the treatment of HCV would be $22,825,343 higher or a total of $157,275,500. Direct medical costs for the treatment of HCV-related complications are however, higher in scenario 1 compare to scenario 2 ($17,093,721,504 vs $16,985,604,114, respectively). The total savings if sofosbuvir was adopted in 2015 would be $85,292,046. Our finding suggests that adopting sofosbuvir in 2015 would still be a cost-saving alternative if the price is cut at least by 40%.

CONCLUSIONS: When evidences show that Intervention is cost-saving, including the drug in the health insurance benefit schemes at the earliest provide higher benefit than prolonged access. Country can use other policy instruments to manage budget impact for example, risk sharing agreement.