PharmacoEconomics & Outcomes News 784, p30 - 12 Aug 2017
Universal HCV treatment
cost effective in Italy
Universal treatment of hepatitis C virus (HCV) at any
fibrosis stage appears to be cost effective in Italy,
compared with treatment of prioritised patients and
those with fibrosis stage F3 (policy 2), according to
findings of a study published in Hepatology.
A Markov model of liver disease progression
populated with data from the PITER cohort (May
December 2015) was used to evaluate the
cost effectiveness of direct-acting antiviral (DAA)
treatment in 8125 DAA-na
ıve patients with chronic
HCV, under a universal policy versus policy 2
(prioritised/F3), from the perspective of the Italian
National Health Service over a lifetime time horizon. The
assumed treatment cost for DAA was €15 000 per
In the base-case analysis in Italy, universal treatment
was estimated to gain 93 131 QALYs at a cost of
€301 788 399, while policy 2 gained 89 490 QALYs at a
cost of €269 841 561, resulting in an estimated
incremental cost-effectiveness ratio (ICER) for universal
DDA treatment versus policy 2 of €8775 per QALY
gained. The ICER was below the willingness-to-pay
(WTP) threshold of €20 000
€40 000 per QALY gained.
In probabilistic sensitivity analysis, ICERs were below
the lower WTP threshold in 94% of simulations and
below the upper threshold in 97% of simulations.
In a European scenario analysis, assuming a treatment
cost of €30 000 and using data from France, Germany,
Italy, Romania and the UK, the ICER for universal
treatment was €19 542 per QALY gained. ICERs ranged
from €9108 per QALY gained at a DDA cost of €15 000
to €26 498 per QALY gained at a DDA cost of €40 000.
"Extending HCV treatment to patients at any fibrosis
stage improves health outcomes and is cost effective.
Cost-effectiveness significantly increases when lowering
treatment prices in early fibrosis stages," concluded the
authors. At DDA prices less than 75% of the €15 000
base price, universal treatment in patients with fibrosis
F2 became dominant (more effective and less
costly) compared with prioritised treatment.
Kondili LA, et al. Modelling cost-effectiveness and health gains of a "universal"
vs. "prioritized" HCV treatment policy in a real-life cohort. Hepatology : 24 Jul
2017. Available from: URL: http://doi.org/10.1002/hep.29399
PharmacoEconomics & Outcomes News 12 Aug 2017 No. 7841173-5503/17/0784-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved