Cost-Effectiveness of Sofosbuvir-Based Treatments for HCV
Cost-Effectiveness of Sofosbuvir-Based Treatments for HCV
Our analyses show that Viekira Pak is cost-effective for genotype 1 patients without cirrhosis, while Harvoni is cost-effective for genotype 1 patients with cirrhosis. Sofosbuvir-based treatments for genotype 1, in general, are not cost-effective due to its substantial high costs. The price of Sofosbuvir would need to be reduced by at least 30 % in order for olysio + sovaldi and sofosbuvir + peginterferon + ribavirin to achieve cost-effectiveness. For genotypes 2 and 3, sofosbuvir + ribavirin as initial treatment comes with a large increase in cost and a small increase in effectiveness. It is not recommended as an initial treatment for patients with genotypes 2 and 3, with the exception of genotype 3 with cirrhosis, in which case, a 24-week sofosbuvir + ribavirin treatment is cost-effective as it leads to much higher SVR compared to alternative treatments. As a second-phase treatment for genotypes 2 and 3, sofosbuvir + ribavirin is cost-effective following peginterferon + ribavirin as initial treatment.
To assure the robustness of our results, we performed sensitivity analyses over wide ranges for all model parameters, and the results did not significantly impact our final conclusions. However, it is important to note that the results obtained in this study should be interpreted within the model assumptions, and there are several limitations. First, model parameters were obtained from the literature and there is limited data on sofosbuvir-involved treatment. Further, the SVR rates used from the five trials targeted different patient cohorts. Bias in these past studies could impact the results presented here. In addition, the Markov model used in the analysis is a simplified representation of disease progression based on aggregate population transitions. Although we believe that we have captured the primary stages, a higher fidelity model could lead to different conclusions. Finally, the population data is specific to the United States, and so the results might not be directly applicable to other countries.
Discussion
Our analyses show that Viekira Pak is cost-effective for genotype 1 patients without cirrhosis, while Harvoni is cost-effective for genotype 1 patients with cirrhosis. Sofosbuvir-based treatments for genotype 1, in general, are not cost-effective due to its substantial high costs. The price of Sofosbuvir would need to be reduced by at least 30 % in order for olysio + sovaldi and sofosbuvir + peginterferon + ribavirin to achieve cost-effectiveness. For genotypes 2 and 3, sofosbuvir + ribavirin as initial treatment comes with a large increase in cost and a small increase in effectiveness. It is not recommended as an initial treatment for patients with genotypes 2 and 3, with the exception of genotype 3 with cirrhosis, in which case, a 24-week sofosbuvir + ribavirin treatment is cost-effective as it leads to much higher SVR compared to alternative treatments. As a second-phase treatment for genotypes 2 and 3, sofosbuvir + ribavirin is cost-effective following peginterferon + ribavirin as initial treatment.
To assure the robustness of our results, we performed sensitivity analyses over wide ranges for all model parameters, and the results did not significantly impact our final conclusions. However, it is important to note that the results obtained in this study should be interpreted within the model assumptions, and there are several limitations. First, model parameters were obtained from the literature and there is limited data on sofosbuvir-involved treatment. Further, the SVR rates used from the five trials targeted different patient cohorts. Bias in these past studies could impact the results presented here. In addition, the Markov model used in the analysis is a simplified representation of disease progression based on aggregate population transitions. Although we believe that we have captured the primary stages, a higher fidelity model could lead to different conclusions. Finally, the population data is specific to the United States, and so the results might not be directly applicable to other countries.