Despite High Drug Cost, Advanced Anti-HCV Targeted Therapies are Cost-Saving

Drug cost mitigated by savings in health care costs on management of conditions that may result from chronic hepatitis C virus.

Drug cost mitigated by savings in health care costs on management of conditions that may result from chronic hepatitis C virus.

In a January 2015 report, researchers associated with leading health insurer Blue Cross Blue Shield (BCBS) analyzed the cost and effectiveness of treatments for new direct-acting antiviral treatment for hepatitis C. According to the insurer’s analysis, available evidence rates these novel therapies as cost-effective when used broadly, and cost-saving when used in patients with certain HCV-related comorbidities.

The high cost of these drugs is ameliorated by the cures they generate and the savings in health care costs on management of chronic liver disease, cirrhosis, and liver cancers that may result from untreated or unsuccessfully treated chronic hepatitis C virus infection (HCVI). In many cases, cure of chronic HCVI ultimately offsets the cost of expensive direct-acting antiviral agents.

In its analysis, BCBS researchers identified a total of 3 peer-reviewed studies addressing the cost/benefit balance of treatment with such direct-acting agents as sofosbuvir and simeprevir.

In the first study, analyzed from the perspective of the Italian health care system, treatment with sofosbuvir over the inferior treatment telaprevir was cost effective, with each additional year of life gained in populations receiving sofosbuvir incurring approximately $33,000 in additional costs. This falls below the $50,000 to $100,000 threshold per additional life-year gained that is commonly used in pharmacoeconomic analyses.

In the French health care system, a similar analysis of sofosbuvir-based treatment over inferior comparator treatments resulted in nearly $22,000 in additional costs to grant 1 additional quality-adjusted life-year. Much of this benefit may be attributable to reductions in the costs of cirrhosis management. As in the Italian analysis, results of the French analysis show the value of sofosbuvir falling well within the normal willingness to pay bounds for sustainable financial management of health care systems.

The final analysis identified by BCBS researchers estimated the costs versus benefits of sofosbuvir-based treatment over inferior treatments with protease inhibitors, such as telaprevir and boceprevir among patients in the United States. This analysis simulated the costs of sofosbuvir in patients at high priority for receipt of direct-acting antiviral agents, including patients with HCV and HIV coinfection, and treatment-experienced patients who failed to achieve cure with prior therapies.

In these more vulnerable populations, sofosbuvir treatment was not only cost-effective, it was a dominant treatment, meaning it was both less expensive than telaprevir- or boceprevir-based regimens, and simultaneously improved health outcomes by a greater margin. In other words, for patients with HIV and HCV coinfection, and in treatment-experienced patients, sofosbuvir-based therapy actually both improves health outcomes and saves insurer resources by reducing spending on other medical costs, more than offsetting the cost of the drug.

This cost-effectiveness analysis is consistent with the current US recommendations for use of novel anti-HCV agents. Current guidelines published jointly by the American Association for the Study of Liver Disease and the Infectious Disease Society of America (available at HCVGuidelines.org) recommend treating patients in order of priority. The highest priority was assigned to patients with HCVI and certain other risk factors, such as HIV coinfection, advanced liver fibrosis (METAVIR score of F3 or F4), receipt of an organ transplant, or extrahepatic manifestations of HCVI, such as cryoglobulinemic vasculitis or membranoproliferative glomerulonephritis.

As shown by the US analysis of sofosbuvir-based therapy over inferior treatments in more vulnerable patients with HCVI, in spite of its high cost, researchers found that sofosbuvir-based regimens both improves health outcomes and saves costs for insurers. Although the cost of anti-HCV therapy with direct-acting agents is very high, the ultimate costs of chronic HCV infection are potentially higher still.

By some estimates, losses in productivity in patients with chronic HCVI exceed $8000 per patient per year. In addition, if chronic HCVI goes untreated, the 10% to 20% of patients with chronic HCVI who develop cirrhosis and hepatocellular carcinoma will ultimately require a liver transplant. Not only are supplies of healthy human livers limited, but the cost of a single liver transplant exceeds $577,000.

With high medical costs like these counterbalancing the cost of direct-acting antivirals, it is not surprising that pharmaceutical developers have placed a high premium on these new treatments. Although they come at high cost, novel oral agents that reliably cure chronic HCVI will ultimately shrink spending and improve overall population health when they are used in patients at the highest risk for medical complications.

References

  • Mark DH; Blue Cross Blue Shield Asssociation. Special report: cost-effectiveness studies of new hepatitis C treatments. Technol Eval Cent Assess Program Exec Summ. 2015;29(10):1-20.
  • AASLD/IDSA HCV Guidelines. www.hcvguidelines.org/fullreport. Accessed June 2015.
  • Micromedex. Red Book. www.thomsomhc.com. Accessed June 2015.
  • Su J, Brook RA, Kleinman NL, Corey-Lisle P. The impact of hepatitis C virus infection on work absence, productivity, and healthcare benefit costs. Hepatology. 2010;52(2):436-442.
  • Smith M. Treating HCV: Is the Price Right? http://www.medpagetoday.com/Gastroenterology/Hepatitis/44357. Accessed June 2015.