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Cited by 19Hepatitis C virus researchHealth Systems, Economic Evaluations, Quality of LifePharmaceutical Economics and Policy

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Cost Effectiveness and Cost Containment in the Era of Interferon-Free Therapies to Treat Hepatitis C Virus Genotype 1

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Linas, Benjamin P., Morgan, Jake R., Pho, Mai T., Leff, Jared A., Schackman, Bruce R., Horsburgh, C. Robert, Assoumou, Sabrina A., Salomon, Joshua A., Weinstein, Milton C., Freedberg, Kenneth A., Kim, Arthur Y.·2017·Open Forum Infectious Diseases
DOI 10.1093/ofid/ofw266PMC PMC5414108
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Abstract

Background: Interferon-free regimens to treat hepatitis C virus (HCV) genotype 1 are effective but costly. At this time, payers in the United States use strategies to control costs including (1) limiting treatment to those with advanced disease and (2) negotiating price discounts in exchange for exclusivity. Methods: We used Monte Carlo simulation to investigate budgetary impact and cost effectiveness of these treatment policies and to identify strategies that balance access with cost control. Outcomes included nondiscounted 5-year payer cost per 10000 HCV-infected patients and incremental cost-effectiveness ratios. Results: We found that the budgetary impact of HCV treatment is high, with 5-year undiscounted costs of $1.0 billion to 2.3 billion per 10000 HCV-infected patients depending on regimen choices. Among noncirrhotic patients, using the least costly interferon-free regimen leads to the lowest payer costs with negligible difference in clinical outcomes, even when the lower cost regimen is less convenient and/or effective. Among cirrhotic patients, more effective but costly regimens remain cost effective. Controlling costs by restricting treatment to those with fibrosis stage 2 or greater disease was cost ineffective for any patient type compared with treating all patients. Conclusions: Treatment strategies using interferon-free therapies to treat all HCV-infected persons are cost effective, but short-term cost is high. Among noncirrhotic patients, using the least costly interferon-free regimen, even if it is not single tablet or once daily, is the cost-control strategy that results in best outcomes. Restricting treatment to patients with more advanced disease often results in worse outcomes than treating all patients, and it is not preferred.

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  • Some drugs that were not a good value for money at higher prices later became acceptable options when prices were lowered, as observed in hepatitis C.

    “our team and others found that some drugs that were not a good value for money at higher prices, later became acceptable options when prices were lowered.44,45”

    From Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder (2023) · cites this paper as [45]

    The Results (Cost Control by Negotiating Price Discounts and Requiring Use of Preferred Drugs; page unavailable) show that an HCV regimen could meet the cost-effectiveness threshold at a lower cost but exceed it at a higher cost. The Conclusions also say lower drug costs improve cost effectiveness. These are modeled price comparisons, not evidence that particular drugs later became acceptable after their prices actually fell. (LLM, conf=0.84)

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Metadata

Authors
Linas, B. P., Morgan, J. R., Pho, M. T., Leff, J. A., Schackman, B. R., Horsburgh, C. R., Assoumou, S. A., Salomon, J. A., Weinstein, M. C., Freedberg, K. A., & Kim, A. Y.
Affiliations
  • Boston University (US)
  • Boston Medical Center (US)
  • University of Chicago (US)
  • Weill Cornell Medicine (US)
  • Harvard University (US)
  • Massachusetts General Hospital (US)
Corresponding author
Linas, Benjamin P.
ORCID
Venue
Open Forum Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2016-12-27
Volume
4
Issue
1
Pages
ofw266-ofw266
ISSN
2328-8957 (ISSN-L)
DOI
10.1093/ofid/ofw266
PMC
PMC5414108
OpenAlex
W2563301157
Cited by
19
References
2
Citations by year
2023: 3 · 2022: 7 · 2019: 2 · 2018: 6 · 2017: 1
FWCI
2.17
Type
journal article
Language
en
Open access
Licence
Locations
  • Open Forum Infectious Diseases (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • National Institute on Drug Abuse (R01DA031059,, P30DA040500)
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Hepatology › Hepatitis C virus research
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
Keywords
hepatitis C virus, HCV genotype 1, interferon-free therapy, cost-effectiveness, cost containment, budget impact, liver cirrhosis, fibrosis stage, treatment access, discounts, antiviral therapy

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