Long-Term Health and Economic Analysis of Direct-Acting Antivirals for Chronic Hepatitis C Treatment

According to Nyberg L. and colleagues, direct-acting antivirals (DAA) have emerged as a breakthrough in the treatment of patients with chronic hepatitis C virus (HCV). In their article, presented at AMCP 2022, the researchers assessed cases from the Kaiser Permanente Southern California (KPSC) health care delivery system to evaluate the health and economic advantages of DAAs versus no treatment. They reported that treatment with DAAs reduced HCV-related morbidity and mortality and significantly improved quality-adjusted life-years (QALYs) for patients with HCV in the real world over the long-term.

Moreover, the study’s authors calculated that the use of DAAs was both less costly and more effective compared to no treatment, with cost-savings being realized within three years of treatment.

The researchers developed a hybrid decision-tree and Markov model to assess the health and direct medical cost outcomes of long-term DAA treatment versus no treatment. DAA agents in the KPSC dataset included sofosbuvir/velpatasvir (SOF/VEL) and ledipasvir/sofosbuvir (LDV/SOF). Based on total number of DAA treated patients from 2014 to 2019, the team formed a cohort of 7,255 subjects with HCV and simulated their health and economic outcomes over a 50-year time period. The efficacy of DAA treatment for each subpopulation was determined by a secondary analysis of KPSC data, and treatment costs were sourced from publicly available databases.

Among the DAA patients, approximately 78% of patients received LDV/SOF, while 22% received SOF/VEL. According to the authors, when compared to no treatment, the use of DAAs yielded a reduction of 3,179 cirrhosis cases (–98%), 3,318 decompensated cirrhosis cases (–96%), 646 hepatocellular carcinoma cases (–80%), 447 liver transplant cases (–86%) and 3,078 liver-related mortalities (–86%). Furthermore, the use of DAAs improved life-years and QALYs by 25% (+3.21 life years) and 36% (+ 3.53 QALYs), respectively, compared to no treatment. Lastly, the authors calculated a 72% reduction in total costs (–$144,592) per subject which, as noted, was estimated to provide cost savings within three years.

Nyberg and the study’s collaborators posited that their analysis of long-term, real-world data supported both health and economic advantages in DAA use versus no treatment for patients with chronic HCV, ultimately highlighting “the substantial value of DAA treatment offered to HCV patients.”