Cost-utility analysis of direct-acting antivirals for treatment of chronic hepatitis C genotype 1 and 6 in Vietnam

Due, O. T., Thakkinstian, A., Thavorncharoensap, M., Sobhonslidsuk, A., Wu, O. , Phuong, N. K. and Chaikledkaew, U. (2020) Cost-utility analysis of direct-acting antivirals for treatment of chronic hepatitis C genotype 1 and 6 in Vietnam. Value in Health, 23(9), pp. 1180-1190. (doi: 10.1016/j.jval.2020.03.018) (PMID:32940236) (PMCID:PMC7491253)

Abstract

Objective: Very few cost-utility analyses have either evaluated direct-acting antivirals (DAAs) on hepatitis C virus (HCV) genotype 6 patients or undertaken societal perspective. Recently, DAAs have been introduced into the Vietnamese health insurance drug list for chronic hepatitis C (CHC) treatment without empirical cost-effectiveness evidence. This study was conducted to generate these data on DAAs among CHC patients with genotypes 1 and 6 in Vietnam. Methods: A hybrid decision-tree and Markov model was employed to compare costs and quality-adjusted life-years (QALYs) of available DAAs, including (1) sofosbuvir/ledipasvir, (2) sofosbuvir/velpatasvir, and (3) sofosbuvir plus daclatasvir, with pegylated-interferon plus ribavirin (PR). Primary data collection was conducted in Vietnam to identify costs and utility values. Incremental cost-effectiveness ratios were estimated from societal and payer perspectives. Uncertainty and scenario analyses and value of information analyses were performed. Results: All DAAs were cost-saving as compared with PR in CHC patients with genotypes 1 and 6 in Vietnam, and sofosbuvir/velpatasvir was the most cost-saving regimen, from both societal and payer perspectives. From the societal perspective, DAAs were associated with the increment of quality-adjusted life-years by 1.33 to 1.35 and decrement of costs by $6519 to $7246. Uncertainty and scenario analyses confirmed the robustness of base-case results, whereas the value of information analyses suggested the need for further research on relative treatment efficacies among DAA regimens. Conclusions: Allocating resources for DAA treatment for HCV genotype 1 and 6 is surely a rewarding public health investment in Vietnam. It is recommended that the government rapidly scale up treatment and enable financial accessibility for HCV patients.

• Item Type: Articles
• Additional Information: This work was part of training at Mahidol University Health Technology Assessment (MUHTA) Program, which scholarship was provided by Mahidol University and the International Decision Support Initiative (iDSI). This work was produced as part of the International Decision Support Initiative (www.idsihealth.org), which supports countries to get the best value for money from health spending. iDSI receives funding support from the Bill & Melinda Gates Foundation, the UK Department for International Development, and the Rockefeller Foundation.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wu, Professor Olivia
• Authors: Due, O. T., Thakkinstian, A., Thavorncharoensap, M., Sobhonslidsuk, A., Wu, O., Phuong, N. K., and Chaikledkaew, U.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Value in Health
• Publisher: Elsevier
• ISSN: 1098-3015
• ISSN (Online): 1524-4733
• Published Online: 20 July 2020
• Copyright Holders: Copyright © 2020 ISPOR-The Professional Society for Health Economics and Outcomes Research
• First Published: First published in Value in Health 23(9): 1180-1190
• Publisher Policy: Reproduced under a Creative Commons License