Cost-effectiveness of antiviral therapy in treatment-naive patients with chronic hepatitis C (genotype 1)

Interferon-free therapy for genotype 1 hepatitis C are preferable from the point of view of clinical effectiveness and safety.

The purpose of work was the assessment of costs and costeffectiveness of regimens for the treatment of HCV (1 genotype) at the treatment-naive patients.

Methods. The assessment was carried out from the payer perspective. In base case the analysis of costs of the drugs included and recommended for inclusion in the List of VED was carried out on the basis of a median of the registered prices including VAT and the average wholesale extra charge taking into account population in the Russian Federation.

Besides, the scenario with the assessment on the basis of the prices of all drugs (which both are included, and not included in the List by VED) revealed in auctions for 2016 is analysed.

Results. In the base case cost of paritaprevir/ombitasvir/ dasabuvir/ritonavir (PTV/OBV/DSV/r) therapy in patients without cirrhose is 12,2-26,6% less compared with simeprevir with pegylated interferon alfa and ribavirin (PegIFN/RBV/ SMV) at a full course of the last (12 weeks) at all patients. In scenario with refusal of inefficient therapy with PegIFN/ RBV/SMV after 4 weeks, PTV/OBV/DSV/r is characterized by the comparable volume of expenses – from decrease by 15,5% to increase by 3,2%.

The analysis on the basis of the prices of auctions has shown that in comparison with the PegIFN/RBV/SMV (without refusal of inefficient therapy with PegIFN/RBV/SMV after 4 weeks) and daclatasvir and asunaprevir, economy at therapy by a PTV/OBV/DSV/r will make 4,1-19,8% and 28,3%, respectively. In comparison with PegIFN/RBV/SMV (with refusal of therapy in the absence of effect in 4 weeks) PTV/OBV/DSV/r is characterized by the comparable volume of expenses (from decrease by 7,5% to increase by 12,8%). In genotype 1b costs of PTV/OBV/DSV/r are 24,6% higher compared with narlaprevir in a combination with ritonavir, peginterferon and ribavirin.

Cost-effectiveness of PTV/OBV/DSV/r is higher at patients without cirrhosis in comparison with all analysed alternatives, except for a narlaprevir in a combination with ritonavir, peginterferon and ribavirin (genotype 1b).

At patients with cirrhosis the analysis on the basis of the registered prices has shown that at a full cycle of therapy decrease in costs of a PTV/OBV/DSV/r ± RBV will make 8,4% in comparison with the PegIFN/RBV/SMV, but at refusal of PegIFN/RBV/SMV in 4 weeks in the absence of the response, additional expenses on PTV/OBV/DSV/r ± RBV will make 5,6%.

In the analysis on the basis of the prices of auctions PTV/ OBV/DSV/r ± RBV will allow to lower expenses at patients with cirrhosis on average by 11,9% in comparison with the daclatasvir and asunaprevir. In comparison with PegIFN/ RBV/SMV PTV/OBV/DSV/r ± RBV or it doesn’t influence expenses (at a full course of a simeprevir at all patients), or it increases them by 15,2% (at refusal of therapy in the absence of the response in 4 weeks). The cost-effectiveness of PTV/ OBV/DSV/r ± RBV surpasses all comparators at patients with cirrhosis, as well as at patients without cirrhosis. The sensitivity analysis has shown high reliability of the received results.

Conclusions. Costs of PTV/OBV/DSV/r ± RBV at treatment-naive patients with HCV (1 genotype) without cirrhosis and with the compensated cirrhosis, are comparable to costs of a PegIFN/RBV/SMV at higher clinical and economic effectiveness.

Taking into account the need for repeated courses of therapy to treatment-naive patients with the compensated cirrhosis, now purpose of a PTV/OBV/DSV/r ± RBV in the first line of therapy is the most preferable economically.

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