Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/114010
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Type: Journal article
Title: A clinician's guide to the cost and health benefits of hepatitis C cure assessed from the individual patient perspective
Author: McEwan, P.
Selvapatt, N.
Brown, A.
Thursz, M.
Bennett, H.
Webster, S.
Kalsekar, A.
Yuan, Y.
Brenner, M.
Gordon, J.
Citation: European Journal of Gastroenterology and Hepatology, 2017; 29(2):208-214
Publisher: Lippincott Williams & Wilkins
Issue Date: 2017
ISSN: 0954-691X
1473-5687
Statement of
Responsibility: 
Phil McEwan, Nowlan Selvapatt, Ashley Brown, Mark Thursz, Hayley Bennett, Samantha Webster, Anupama Kalsekar, Yong Yuan, Michael Brenner, Jason Gordon
Abstract: Background and aims: The hepatitis C virus (HCV) remains a considerable public health challenge. Novel direct-acting antiviral (DAA) regimens offer high cure rates and the promise of reduced HCV incidence and prevalence following the up-scaling of treatment. This has focused attention towards affordability. This study aimed to estimate the economic value of cure to evaluate the treatment costs justifiable from the patient perspective. Patients and methods: A published, validated HCV model was utilized to contrast clinical and cost outcomes for patients aged 30–70 years, stratified by METAVIR F0–F4, for (i) no treatment and (ii) successful treatment [i.e. sustained virologic response (SVR)] ignoring the cost of treatment. Regression equations were fitted and used to determine the financial expenditure justifiable to achieve a cost-neutral or a cost-effective [£20 000 per quality-adjusted life-year (QALY)] cure. Model inputs were derived from UK literature; costs and utilities were discounted at 3.5% over a lifetime horizon. Results: To achieve cost-neutrality, the maximum discounted expenditure justifiable for SVR was £3774–43 607 across ages and fibrosis stages. Spending between £19 745 (70 years, F0) and £188 420 (30 years, F4) on SVR is expected to be cost-effective at £20 000/QALY willingness-to-pay threshold. Conclusion: Heterogeneity across HCV patients is considerable, which can obscure the relevance of conventional cohort-based economic models evaluated at the mean, particularly when considering the value of treatment at the individual patient level. By quantifying the full exposition of HCV cost-savings and health benefits realizable following HCV cure, this study provides insight into the economic value of successful treatment from the patient perspective.
Keywords: Cost-effectiveness; direct-acting antivirals; hepatitis C virus; sustained virologic response
Rights: © 2017 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/MEG.0000000000000773
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