Cost-effectiveness analysis of glecaprevir/pibrentasvir regimen for treating Chinese patients with chronic hepatitis C genotype 1 and genotype 2 infection.
BACKGROUND
Hepatitis C virus (HCV) infection is an important health threat in China to which direct acting antivirals (DAAs) are very effective. In 2019, another novel DAA glecaprevir/pibrentasvir (GLE/PIB) was officially approved. Knowledge of its cost-effectiveness would be informative for clinical decision-making but has not been evaluated. This study aims to evaluate the cost-effectiveness of GLE/PIB to inform policy-making on drug reimbursement and HCV eradication.


METHODS
Markov models were developed from the payers' perspective and simulated the lifetime experience of adult patients chronically infected with HCV genotype 1 or genotype 2. Two regimens, GLE/PIB and pegylated interferon (pegIFN) plus ribavirin (RBV), were compared in cost and quality adjusted life years (QALY) with both outcomes being discounted to 2020 values. The incremental cost-effectiveness ratio (ICER) was computed to reflect the incremental benefit of GLE/PIB versus pegIFN + RBV. The robustness of the model outcomes was examined using deterministic and probabilistic sensitivity analysis (PSA) to identify influential parameters and to assess the probability of GLE/PIB being cost-effective. The GDP per capita in China in 2019 ($10,275) was used as the threshold for cost-effectiveness.


RESULTS
For the entire target population, GLE/PIB was the dominant regimen attaining a cost-saving of $255 and 1.17 more QALYs relative to pegIFN + RBV. The finding was more pronounced for HCV genotype 1 infection by saving $1,656 and creating 1.37 more QALYs. At the $10,275 threshold, the probability of GLE/PIB being cost-effective was 99.32% overall and 99.85% for HCV genotype 1 infection. The age of starting DAA treatment, price of pegIFN + RBV, cost of cirrhosis treatment and duration of the GLE/PIB regimen were the five most influential factors. For the patients with HCV genotype 2 infection, the ICER of GLE/PIB was $12,914/QALY with 95% confidence interval of $4,047/QALY to $37,640/QALY. The GLE/PIB regimen statistically cannot be ruled out as a cost-effective option for HCV genotype 2 infection.


CONCLUSIONS
GLE/PIB is a cost-effective strategy to treat chronic HCV genotype 1 and HCV genotype 2 infection in China. This regimen should be initiated at a younger age to maximize its value. To achieve national eradication, it may be timely to consider replacing pegIFN + RBV with DAAs, such as GLE/PIB, as the first-line treatment.
['Zhou|Hui-Jun|HJ|', 'Wu|Gang|G|', 'Li|Ji-Ming|JM|', 'Naidoo|Nasheen|N|', 'Xie|Yan-Xiang|YX|', 'Feng|Bo-Lan|BL|', 'Wang|Pei|P|', 'Luo|Ji-Wei|JW|']
D000328:Adult D000621:Aminoisobutyric Acids D000998:Antiviral Agents D001562:Benzimidazoles D002681:China D003362:Cost-Benefit Analysis D003521:Cyclopropanes D004359:Drug Therapy, Combination D005838:Genotype D019698:Hepatitis C, Chronic D006801:Humans D047029:Lactams, Macrocyclic D007930:Leucine D011392:Proline D011759:Pyrrolidines D011810:Quinoxalines D013449:Sulfonamides
cost-effectiveness hepatitis C virus (HCV) direct acting antiviral (DAA) Glecaprevir/pibrentasvir (GLE/PIB) Markov model health economics