Table 6.

Highly Stratifying the Population and the Cost-Effectiveness of Treat All

Reference	Country	Genotype	Analysis		Model Features			Population			LMIC	Newest Drug(s)	Comparator(s)	ICER ($/QALY Gained)	Currency (Year)	Notes
			Fibrosis Stratified	Delay Considered	Model Typea	Transmission	Reinfection	PWID Focus	Incarcerated	Highly Stratified
Ciaccio, 201759	Italy	1–4	Yes	No	M	No	No	No	No	Yes	NO	All-oral DAA treatment for people 65–85 by fibrosis stage and frailty	No treatment	<40,000 for younger, less, frail, more advanced fibrosis, and GT1	€ (2013)	Older individuals, especially when frail, with F1 or F2 and with GT2 or 3 have ICERs >40,000 per QALY gained. All ICERs are likely is biased toward cost-effectiveness in general because the analysis does not consider delaying treatment to later fibrosis stages.
Cure, 201568	Italy	1–6	No	No	M	No	Yes	No	No	Yes	NO	SOF-based therapy relative to others defined by cirrhosis, prior treatment, and genotype	Appropriate treatment regimens or no treatment	<40,000 for most groups	€ (2013)	Above the WTP threshold for treatment naïve GT4, 5, 6 and for some noncirrhotic groups. Given that delay is not considered it may be the case that a greater number of non-cirrhotic groups would have ICERs above the WTP threshold.
Cure, 201569	UK	1–6	No	No	M	No	Yes	No	No	Yes	NO	SOF-based therapy relative to others defined by prior treatment, interferon eligible, and genotype	Appropriate treatment regimens or no treatment	<20,000 for most groups	£ (2011)	For GT2, 3, 4, 5, 6 who are treatment naïve and unable to take interferon SOF triple therapy had an ICER >20,000/QALY gained. Given that delay is not considered it may be the case that a greater number of treatment experienced and/or interferon eligible groups would have ICERs above the threshold.
Elbasha, 201770	US	1	Yes	No	M	No	Yes	No	No	Yes	NO	EBR/GZR ± ribavirin for noncirrhotic/cirrhotic, treatment experienced/naïve patients	Other all oral DAAs (SOF-LDV, 3D)	<26,000	US$ (2015)	Subgroup analyses showed that even at F0, the ICER was <$60,000 per QALY gained. Given that delay is not considered it may be the case that the ICERs estimated are overly favorable.

3D, paritaprevir/ritonavir-ombitasvir and dasabuvir; DAA, direct-acting antiviral; EBR/GZR, elbasvir/grazoprevir; F0, F1, F2, F3, F4, indicates severity of patient’s liver disease using metavir fibrosis scale (“≥F2” indicates all patients with at least F2 fibrosis which is F2, F3, and F4); ICER, incremental cost-effectiveness ratio; LMIC, low- and middle-income countries; PWID, people who inject drugs; QALY, quality-adjusted life year; SOF, sofosbuvir; SOF-LDV, sofosbuvir/ledipasvir; WTP, willingness to pay.

^a.Model type: M, Markov model; DT, dynamic transmission model; MS, microsimulation; AB, agent-based simulation.