Cost Effectiveness of HCV Prevention & Treatment

Cost Effectiveness of Harm Reduction
David P. Wilson, Braedon Donald, Andrew J. Shattock, David Wilson, Nicole Fraser-Hurt; International Journal of Drug Policy 26 (2015) 55-511

Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets

Cost Effectiveness of Sofosbuvir Regimens
Benjamin P. Linas, MD, MPH; Devra M. Barter, MS; Jake R. Morgan, MS; Mai T. Pho, MD, MPH; Jared A. Leff, MS; Bruce R. Schackman, PhD; C. Robert Horsburgh, MD, MUS; Sabrina A. Assoumou, MD, MPH; Joshua A. Salomon, PhD; Milton C. Weinstein, PhD; Kenneth A. Freedberg, MD, MSc; and Arthur Y. Kim, MD; Ann Intern Med. 2015;162:619-629. doi:10.7326/M14-1313

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, sofosbuvirbased regimens for treatment-naive noncirrhotic patients exceed willingness-to-pay thresholds commonly cited in the United States

Health and Cost Benefits of New HCV Tx
David B. Rein,John S. Wittenborn,Bryce D. Smith,Danielle K. Liffmann,and John W. Ward; Clinical Infectious Diseases® 2015;61(2):157–68

New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing.

Prices for Producing DAAs
Nikolien van de Ven,Joe Fortunak,Bryony Simmons,Nathan Ford,Graham S. Cooke,Saye Khoo,and Andrew Hill; HEPATOLOGY, Month 2014

This analysis aimed to estimate minimum costs of DAA treatment and associated diagnostic monitoring. Clinical trials of HCV DAAs were reviewed to identify combinations with consistently high rates of sustained virological response across hepatitis C genotypes. For each DAA, molecular structures, doses, treatment duration, and components of retrosynthesis were used to estimate costs of large-scale, generic production.

Cost Effectiveness Analysis of LDV/SOF+RBV
Ahmed, A; Dieterich, DT; Park, H; Saab, S; Gordon, SC; Younossi, ZM; DDW 2015 – May 16-19 Wash DC

To evaluate the lifetime health and economic outcomes from a decision-analytic model for LDV/SOF+RBV versus SOF+SMV in GT1 treatment-experienced patients with compensated cirrhosis

Cost-Effectiveness of Hepatitis C Virus Antiviral Treatment for Injection Drug User Populations
Natasha K. Martin,Peter Vickerman,Alec Miners,Graham R. Foster,Sharon J. Hutchinson,David J. Goldberg,and Matthew Hickman, Hepatology 2012

Treatment and prevention of HCV transmission among IDUs, is critical to reducing the burden of liver disease.Prevention measures such as opiate substitution therapy and high coverage needle and syringe programs can reduce HCV transmission. Previous mathematical modeling work suggested HCV antiviral treatment could prevent HCV transmission. Current HCV antiviral treatment regimens can achieve a SVR in 45% (genotype 1) to 80% (genotype 2/3) of infections and economic evaluations suggest treatment is cost-effective for populations with no risk of reinfection.

EMCDDA Workgroup on Costs and Cost-effectiveness of HCV Interventions:
Executive Summary 2014Cost-Effectiveness of Noninvasive Liver Fibrosis Tests for Treatment Decisions in Patients With Chronic Hepatitis C, Tsochatzis, Crossan, et al. HEPATOLOGY, Month 2014

The global aims of the EMCDDA project concern: (1) the estimation of costs for society of problem drug use, and (2) the assessment of the cost-effectiveness of different forms of intervention using models.

Assessing the Cost-Effectiveness of Interventions Aimed at Promoting and Offering Hepatitis C Testing to Injecting Drug Users: An Economic Modelling Report:
Natasha K. Martin, Alec Miners, Peter Vickerman, February 2012

Injecting drug users are at high risk for HCV infection, and interventions to increase diagnoses in this risk group should target both current and former IDUs. The introduction of dried blood spot testing is more acceptable to service users, is associated with increased testing, and likely to be cost-effective in specialist addiction services. Ensuring continuity of care and referral to, from, and between prison will increase the cost-effectiveness of all testing interventions, and is key to ensuring any prison intervention is cost-effective.

Cost-Effectiveness of Noninvasive Liver Fibrosis Tests for Treatment Decisions in Patients With Chronic Hepatitis C,
Tsochatzis, Crossan, et al. HEPATOLOGY, Month 2014

We compared the cost-effectiveness of using NITs to inform treatment decisions in adult patients with chronic hepatitis C (CHC). We conducted a systematic review and meta-analysis to calculate the diagnostic accuracy of various NITs using a bivariate random-effects model

The Cost of Treatment Failure: resource use and costs incurred by hepatitis C virus genotype 1–infected patients who do or do not achieve sustained virological response to therapy:
M. Backx,A. Lewszuk,J. R. White,J. Cole,A. Sreedharan,S. van Sanden,J. Diels,A. Lawson,K. R. Neal,M. J. Wiselka: Journal of Viral Hepatitis, 2014, 21, 208–215

This study quantified the medium-term difference in health resource usage and costs depending on treatment outcome. Achievement of an SVR has significant effects on health service usage and costs. This work provides real-life data for future cost-effectiveness analyses related to the treatment for chronic HCV infection.

Costs of Telaprevir-based Triple Therapy Including Adverse Event Management at the Mount Sinai Medical Center, NYC:
Kian Bichoupan, Valerie Martel-Laferriere, David Sachs, Michel Ng, Emily Schonfeld, Alexis Pappas, James Crismale, Alicia Stivala, Viktoriya Khaitova, Donald Gardenier, Michael Linderman Ponni Perumalswami, Thomas Schiano, Joseph Odin, Lawrence Liu, Douglas Dieterich, Andrea Branch: AASLD 2013, November 2013

This slide presentation from AASLD 2013 provides a unique look at the estimated total costs of TVR-based triple-therapy for chronic genotype 1 HCV in a real world setting in treatment naïve and previously-treated patients from the payer’s perspective

Hepatitis C Virus (HCV) Economic Burden of HCV Backgrounder
Martin Freeman, Janssen Pharmaceutica NV 2013

Overview of economic burden of HCV

Harm Reduction: A Low Cost, High Impact Set of Interventions
HRI 2013

Harm reduction is one of the most rigorously evaluated and best proven public health interventions. A growing body of literature demonstrates the cost of the failure to act and attests to the cost effectiveness of harm reduction programs such as needle and syringe exchange and opioid substitution therapy. Research shows the returns on investment in effective harm reduction are amongst the highest in public health.

Long-Term Effectiveness and Cost-Effectiveness of Screening for Hepatitis C Virus Infection:
Gaby Sroczynski, Eva Esteban, Annette Conrads-Frank, Ruth Schwarzer,Nikolai Mu¨ hlberger, Davene Wright, Stefan Zeuzem, Uwe Siebert European Journal of Public Health, 2009 Vol. 19, No. 3, 245–253

The evidence for long-term effectiveness and cost-effectiveness of HCV screening was systematically reviewed. Seven studies were included. Target population, HCV prevalence, study perspective, discount rate, screening and\ antiviral treatment mode varied. HCV screening seems to be cost-effective in populations with high HCV prevalence, but not in low HCV prevalence populations. HCV screening and early treatment have the potential to improve average life-expectancy, but should focus on populations with elevated HCV prevalence to be cost-effective.

Minimum Costs For Producing Hepatitis C Direct Acting Antivirals, For Use In Large-Scale Treatment Access Programs In Developing Countries
Andrew Hill, Saye Khoo, Joe Fortunak, Bryony Simmons, Nathan Ford, Clinical Infectious Disease, January 2014

Several combinations of two or three DAAs can cure HCV in the majority of treatment-naïve patients. Generic antiretrovirals are currently manufactured at very low prices, to treat 10 million people with HIV/AIDS in developing countries. Within the next 15 years, large-scale manufacture of two or three drug combinations of HCV DAAs is feasible, with minimum target prices of US$100-250 per 12 week treatment course. These low prices could make widespread access to HCV treatment in low and middle income countries a realistic goal.

Infection With Hepatitis B and C Virus in Europe: A Systematic Review of Prevalence and Cost-Effectiveness of Screening
Hahné et al. BMC Infectious Diseases 2013, 13:181

Treatment for chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is improving but not benefiting individuals unaware to be infected. To inform screening policies we assessed (1) the hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus antibody (anti-HCV-Ab) prevalence for 34 European countries; and (2) the cost-effectiveness of screening for chronic HBV and HCV infection.

Sticker Shock and the Price of New Therapies for Hepatitis C: Is It Worth It?
Nancy S. Reau, MD, Donald M. Jensen, MD: Hepatology 2014

A new era of antiviral therapy for hepatitis C holds great promise to finally reign in a public health nightmare, but at what expense? It has been estimated that a 12 week course of therapy could cost in excess of $84,000. Much has been written in the lay press regarding the price of these newer therapies which has led to concerns about the ability of our health care system to effectively implement and deliver these treatments to those in greatest need. Can we justify these costs? To better understand this, it is necessary frame the discussion in the context of the economic burden of chronic liver disease against the retail cost of therapy.