Cost-Utility Analysis of Second-Generation Direct-Acting Antivirals for Hepatitis C

: Introduction: Hepatitis C virus (HCV) could lead to increased mortality, disability, and liver transplant if left untreated, and it is associated with a possible increase in disease burden in the future, all of which would surely have a significant impact on the health system. New antiviral regimens in the treatment of the disease are effective yet expensive. Objective: To performe a cost-effectiveness analysis of three medication regimens, namely, ledipasvir/sofosbuvir (LDV/SOF), velpatasvir/sofosbuvir, and daclatasvir/sofosbuvir (DCV/SOF) in HCV patients with genotype 1 in Iran. Materials and methods: A Markov model with a lifetime horizon was developed to predict the costs and outcomes of the three mentioned medication therapy strategies. The final outcome of the study was quality-adjusted life-years (QALYs) which was obtained using the previously published studies. The study was conducted from the perspective of the Health Ministry; therefore, only direct medical costs were estimated. The results were provided in the incremental cost-effectiveness ratio (ICER) per QALY. Ultimately, the one-way and probabilistic sensitivity analyses were used to measure the strength of study results. Results: The results showed that the QALY for LDV/SOF, DCV/SOF, and VEL/SOF were 13.94, 13.94, and 14.61, and the costs were 4807, 7716, and 4546$, respectively. The VEL/SOF regimen had lower costs and higher effectiveness than the LDV/SOF and DCV/SOF regimens, making it a dominant strategy. The tornado diagram results showed that the study results have the highest sensitivity to CHC and CC state costs. Moreover, the scatter plots results showed that VEL/SOF was the dominant therapeutic strategy in 73% of the simulations compared to LDV/SOF and in 66% of the simulations compared to DCV/SOF; moreover, it was in the acceptable region in 92% of the simulations and below the threshold. Therefore, it was considered the most cost-effective strategy. Moreover, the results showed that DCV/SOF was in the acceptable region below the threshold in 69% of the simulations compared to LDV/SOF. Therefore, DCV/SOF regimen was more cost-effective than LDV/SOF. Conclusion: According to the present study results, it could be recommended that the VEL/SOF regimen be used as the first line of therapy in patients with HCV genotype 1. Moreover, the second-line medication regimen was DCV/SOF.