Table 3.
Cost Effectiveness of Treatment for Hepatitis C Virus Infection Among Genotype 1a and 1b Noncirrhotic Patients Assuming Both “Treat All” and “F2+ Only” Approaches
| Treatment Strategy | Cost, $ | Incremental Cost, $ | QALYs | Incremental QALYs | ICER, $/QALY | SVR, % | Nondiscounted Cost/10 000 Patients, Billion $ |
|---|---|---|---|---|---|---|---|
| Genotype 1a, Treatment-Naive, RNA <6 Million | |||||||
| No treatment | 165 000 | - | 11.5 | - | - | - | 0.37 |
| PEG/RBV 48 weeks | 206 000 | 40 800 | 12.8 | 1.3 | Dominateda | 43.4 | 0.84 |
| SOF/LDV 8 weeks treating only F2+ | 227 000 | 61 900 | 14.4 | 2.9 | 21 700 | 88.6 | 1.02 |
| PEG/RBV/SMV 24 weeks | 231 000 | 3800 | 13.9 | −0.4 | Dominateda | 77.3 | 1.13 |
| SOF/LDV 8 weeks | 233 000 | 5900 | 14.6 | 0.3 | 22 300 | 96.2 | 1.17 |
| PTV/r/OBV/DSV/RBV 12 weeks | 252 000 | 19 000 | 14.7 | 0.0 | 610 000 | 97.6 | 1.36 |
| PEG/RBV/SOF 12 weeks | 266 000 | 14 100 | 14.5 | −0.2 | Dominateda | 92.4 | 1.50 |
| DCV/SOF 12 weeks | 329 000 | 76 500 | 14.7 | 0.1 | 1 520 000 | 99.1 | 2.14 |
| Genotype 1a, Treatment-Naive, RNA ≥6 Million | |||||||
| No treatment | 165 000 | - | 11.5 | - | - | - | 0.37 |
| PEG/RBV 48 weeks | 206 000 | 41 000 | 12.8 | 1.3 | Dominateda | 43.6 | 0.84 |
| PEG/RBV/SMV 24 weeks | 231 000 | 24 700 | 13.9 | 1.1 | Dominateda | 77.2 | 1.13 |
| PTV/r/OBV/DSV/RBV 12 weeks treating only F2+ | 243 000 | 77 900 | 14.4 | 2.9 | 27 100 | 89.8 | 1.17 |
| PTV/r/OBV/DSV/RBV 12 weeks | 252 000 | 8900 | 14.7 | 0.3 | 32 600 | 97.5 | 1.36 |
| SOF/LDV 12 weeks | 261 000 | 8800 | 14.6 | 0.0 | Dominateda | 96.2 | 1.45 |
| PEG/RBV/SOF 12 weeks | 266 000 | 14 100 | 14.5 | −0.2 | Dominateda | 92.3 | 1.50 |
| DCV/SOF 12 weeks | 329 000 | 76 500 | 14.7 | 0.1 | 1 400 000 | 99.1 | 2.14 |
| Genotype 1a, Treatment-Experienced | |||||||
| No treatment | 156 000 | - | 11.5 | - | - | - | 0.39 |
| PTV/r/OBV/DSV/RBV 12 weeks treating only F2+ | 236 000 | 80 400 | 13.9 | 2.3 | Dominateda | 85.6 | 1.21 |
| PTV/r/OBV/DSV/RBV 12 weeks | 245 000 | 89 300 | 14.0 | 0.2 | 28 300 | 95.6 | 1.39 |
| SOF/LDV 12 weeks | 255 000 | 9500 | 14.0 | 0.0 | Dominateda | 94.7 | 1.48 |
| PEG/RBV/SOF 12 weeks | 258 000 | 13 000 | 13.9 | −0.1 | Dominateda | 92.3 | 1.52 |
| DCV/SOF 12 weeks | 320 000 | 74 600 | 14.1 | 0.1 | 700 000 | 98.9 | 2.15 |
| SMV/SOF 12 weeks | 321 000 | 1500 | 13.9 | −0.3 | Dominateda | 88.4 | 2.15 |
| Genotype 1b, Treatment-Naive, RNA <6 Million | |||||||
| No treatment | 165 000 | - | 11.5 | - | - | - | 0.37 |
| PEG/RBV 48 weeks | 206 000 | 40 700 | 12.8 | 1.3 | Dominateda | 43.5 | 0.84 |
| SOF/LDV 8 weeks treating only F2+ | 227 000 | 61 900 | 14.4 | 2.9 | 21 700 | 88.5 | 1.02 |
| PEG/RBV/SMV 24 weeks | 232 000 | 5400 | 14.3 | −0.1 | Dominateda | 87.9 | 1.16 |
| SOF/LDV 8 weeks | 233 000 | 5900 | 14.6 | 0.3 | 22 700 | 96.1 | 1.17 |
| PTV/r/OBV/DSV 12 weeks | 248 000 | 14 900 | 14.7 | 0.1 | 182 000 | 98.4 | 1.32 |
| PEG/RBV/SOF 12 weeks | 266 000 | 18 400 | 14.5 | −0.2 | Dominateda | 92.4 | 1.50 |
| DCV/SOF 12 weeks | 329 000 | 80 800 | 14.7 | 0.0 | 4 190 000 | 99.1 | 2.14 |
| Genotype 1b, Treatment-Naive, RNA ≥6 Million | |||||||
| No treatment | 165 000 | - | 11.5 | - | - | - | 0.37 |
| PEG/RBV 48 weeks | 206 000 | 41 100 | 12.8 | 1.3 | Dominateda | 43.5 | 0.84 |
| PEG/RBV/SMV 24 weeks | 232 000 | 67 200 | 14.3 | 2.8 | 24 400 | 87.8 | 1.16 |
| PTV/r/OBV/DSV 12 weeks treating only F2+ | 239 000 | 6800 | 14.4 | 0.2 | Dominateda | 90.7 | 1.13 |
| PTV/r/OBV/DSV/RBV 12 weeks | 248 000 | 15 200 | 14.7 | 0.4 | 35 500 | 98.4 | 1.32 |
| SOF/LDV 12 weeks | 261 000 | 13 200 | 14.6 | −0.1 | Dominateda | 96.3 | 1.45 |
| PEG/RBV/SOF 12 weeks | 266 000 | 18 400 | 14.5 | −0.2 | Dominateda | 92.4 | 1.50 |
| DCV/SOF 12 weeks | 329 000 | 80 800 | 14.7 | 0.0 | 4 470 000 | 99.1 | 2.14 |
| Genotype 1b, Treatment-Experienced | |||||||
| No treatment | 156 000 | - | 10.8 | - | - | - | 0.39 |
| PTV/r/OBV/DSV/RBV 12 weeks treating only F2+ | 236 000 | 80 200 | 13.7 | 2.8 | Dominateda | 86.1 | 1.21 |
| PTV/r/OBV/DSV/RBV 12 weeks | 245 000 | 89 100 | 14.0 | 3.2 | 28 000 | 96.2 | 1.39 |
| SOF/LDV 12 weeks | 255 000 | 9800 | 14.0 | 0.0 | Dominateda | 94.7 | 1.48 |
| PEG/RBV/SOF 12 weeks | 258 000 | 13 200 | 13.9 | −0.2 | Dominateda | 92.3 | 1.52 |
| DCV/SOF 12 weeks | 320 000 | 75 000 | 14.1 | 0.1 | 814 000 | 99.0 | 2.15 |
| SMV/SOF 12 weeks | 324 000 | 3700 | 14.1 | 0.0 | Dominateda | 98.7 | 2.19 |
Abbreviations: DCV, daclatasvir; DSV, dasabuvir; F2, fibrosis stage F2; HCV, hepatitis C virus; ICER, incremental cost-effectiveness ratio; LDV, ledipasvir; OBV, ombitasvir; PEG, pegylated-interferon; PTV, paritaprevir; QALY, quality-adjusted life year; r, ritonavir; RBV, ribavirin; RNA, ribonucleic acid; SMV, simeprevir; SOF, sofosbuvir; SVR, sustained virologic response.
(NOTE: All values are mean per-person values based on Monte-Carlo simulations of 1 000 000 individuals. Nondiscounted cost per 10000 patients is calculated over 5 years. Cost-effectiveness ratios may not match previous columns due to rounding.)
Dominated = strategies more costly and less effective than a competing strategy or strategies with an ICER greater than that of a more effective strategy.