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The cost-effectiveness of sofosbuvir-based regimens for treatment of hepatitis C virus genotype 2 or 3 infection.
Open accessAbstract
BACKGROUND: Chronic infection with hepatitis C virus (HCV) genotype 2 or 3 can be treated with sofosbuvir without interferon. Because sofosbuvir is costly, its benefits should be compared with the additional resources used. OBJECTIVE: To estimate the cost-effectiveness of sofosbuvir-based treatments for HCV genotype 2 or 3 infection in the United States. DESIGN: Monte Carlo simulation, including deterministic and probabilistic sensitivity analyses. DATA SOURCES: Randomized trials, observational cohorts, and national health care spending surveys. TARGET POPULATION: 8 patient types defined by HCV genotype (2 vs. 3), treatment history (naive vs. experienced), and cirrhosis status (noncirrhotic vs. cirrhotic). TIME HORIZON: Lifetime. PERSPECTIVE: Payer. INTERVENTION: Sofosbuvir-based therapies, pegylated interferon-ribavirin, and no therapy. OUTCOME MEASURES: Discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: The ICER of sofosbuvir-based treatment was less than $100,000 per QALY in cirrhotic patients (genotype 2 or 3 and treatment-naive or treatment-experienced) and in treatment-experienced noncirrhotic patients but was greater than $200,000 per QALY in treatment-naive noncirrhotic patients. RESULTS OF SENSITIVITY ANALYSIS: The ICER of sofosbuvir-based therapy for treatment-naive noncirrhotic patients with genotype 2 or 3 infection was less than $100,000 per QALY when the cost of sofosbuvir was reduced by approximately 40% and 60%, respectively. In probabilistic sensitivity analyses, cost-effectiveness conclusions were robust to uncertainty in treatment efficacy. LIMITATION: The analysis did not consider possible benefits of preventing HCV transmission. CONCLUSION: Sofosbuvir provides good value for money for treatment-experienced patients with HCV genotype 2 or 3 infection and those with cirrhosis. At their current cost, sofosbuvir-based regimens for treatment-naive noncirrhotic patients exceed willingness-to-pay thresholds commonly cited in the United States. PRIMARY FUNDING SOURCE: National Institute on Drug Abuse and National Institute of Allergy and Infectious Diseases.
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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 [44]
The Results (Genotype 2 and 3; Deterministic Sensitivity Analysis, page not specified) show that sofosbuvir-based regimens exceeded the cost-effectiveness threshold at the studied price but fell below it when lower prices were modeled. The paper does not report that prices were subsequently lowered or that the regimens later became acceptable in practice; that temporal claim goes beyond its analysis. (LLM, conf=0.87)
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Metadata
- Authors
- Linas, B. P., Barter, D. M., 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)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2015-05-05
- Volume
- 162
- Issue
- 9
- Pages
- 619-629
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC4420667
- OpenAlex
- W2065146174
- Cited by
- 101
- References
- 47
- Citations by year
- 2023: 4 · 2022: 7 · 2021: 2 · 2020: 6 · 2019: 7 · 2018: 15 · 2017: 19 · 2016: 26 · 2015: 15
- FWCI
- 14.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA027379, R01DA031059)
- National Institute of Allergy and Infectious Diseases (R01AI042006, R37AI042006, P30AI042853)
- 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 2, HCV genotype 3, sofosbuvir, cost-effectiveness, pegylated interferon and ribavirin, liver cirrhosis, treatment-naive patients, treatment-experienced patients, quality-adjusted life years, incremental cost-effectiveness ratio, drug cost reduction, willingness-to-pay threshold, chronic hepatitis C treatment, United States
- MeSH terms
- Sofosbuvir, Antiviral Agents, Cost-Benefit Analysis, Genotype, Humans, Liver Cirrhosis, Markov Chains, Monte Carlo Method, Ribavirin, United States, Uridine Monophosphate, Interferon-alpha, Disease Progression, Quality-Adjusted Life Years, Hepatitis C, Chronic
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