Massachusetts General Hospital Institute for Technology Assessment, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Sci Rep. 2020 Mar 5;10(1):4089. doi: 10.1038/s41598-020-60986-4.
In Japan, 1.5-2 million people are chronically infected with hepatitis C virus (HCV) infection. New direct-acting antiviral agents (DAA) offer an unprecedented opportunity to cure HCV. While the price of HCV treatment decreased recently in most countries, it remains one of the highest in Japan. Our objective was to evaluate the cost-effectiveness of HCV treatment in patients of different age groups and to estimate the price at which DAAs become cost-saving in Japan. A previously developed microsimulation model was adapted to the Japanese population and updated with Japan-specific health utilities and costs. Our model showed that compared with no treatment, the incremental cost-effectiveness ratio (ICER) of DAAs at a price USD 41,046 per treatment was USD 9,080 per quality-adjusted life year (QALY) gained in 60-year-old patients. HCV treatment became cost-effective after 9 years of starting treatment. However, if the price of DAAs is reduced by 55-85% (USD 6,730 to 17,720), HCV treatment would be cost-saving within a 5 to 20-year time horizon, which should serve to increase the uptake of DAA-based HCV treatment. The payers of health care in Japan could examine ways to procure DAAs at a price where they would be cost-saving.
在日本，有 150 万至 200 万人慢性感染丙型肝炎病毒（HCV）。新型直接作用抗病毒药物（DAA）为治愈 HCV 提供了前所未有的机会。尽管最近大多数国家的 HCV 治疗价格有所下降，但在日本仍处于较高水平。我们的目标是评估不同年龄组 HCV 治疗的成本效益，并估算 DAA 的价格在何时能使治疗具有成本效益。我们使用一种预先开发的微模拟模型来评估日本人群，并根据日本特有的健康效用和成本进行了更新。我们的模型显示，与不治疗相比，60 岁患者以 41046 美元/疗程的价格使用 DAA 的增量成本效益比（ICER）为每获得 1 个质量调整生命年（QALY）的成本为 9080 美元。如果开始治疗后 9 年内 HCV 治疗的成本效益比超过 1，那么 HCV 治疗就具有成本效益。然而，如果 DAA 的价格降低 55-85%（6730 美元至 17720 美元），在 5 至 20 年内 HCV 治疗就具有成本效益，这将有助于增加 DAA 为基础的 HCV 治疗的应用。日本的医疗保健支付者可以考虑以具有成本效益的价格采购 DAA。
