Yun Haoya, Zhao Guoqiang, Sun Xiaojie, Shi Lizheng
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China.
BMJ Open. 2020 Aug 20;10(8):e035224. doi: 10.1136/bmjopen-2019-035224.
This study aimed to estimate the cost-utility of sofosbuvir/velpatasvir (SOF/VEL) compared with other direct-acting antivirals (DAAs) in Chinese patients with hepatitis C virus (HCV).
A Markov model was developed to estimate the disease progression of patients with HCV over a lifetime horizon from the healthcare system perspective. Efficacy, clinical inputs and utilities were derived from the published literature. Drug costs were from the market price survey, and health costs for Markov health states were sourced from a Chinese study. Costs and utilities were discounted at an annual rate of 5%. One-way and probabilistic sensitivity analyses were conducted to test the impact of input parameters on the results.
SOF/VEL was compared with sofosbuvir+ribavirin (SR), sofosbuvir+dasabuvir (SD), daclatasvir+asunaprevir (DCV/ASV), ombitasvir/paritaprevir/ritonavir+dasabuvir (3D) and elbasvir/grazoprevir (EBR/GZR).
Costs, quality-adjusted life years (QALYs) and incremental cost-utility ratios (ICURs).
SOF/VEL was economically dominant over SR and SD. However, 3D was economically dominant compared with SOF/VEL. Compared with DCV/ASV, SOF/VEL was cost-effective with the ICUR of US$1522 per QALY. Compared with EBR/GZR, it was not cost-effective with the ICUR of US$369 627 per QALY. One-way sensitivity analysis demonstrated that reducing the cost of SOF/VEL to the lower value of CI resulted in dominance over EBR/GZR and 3D. Probabilistic sensitivity analysis demonstrated that 3D was cost-effective in 100% of iterations in patients with genotype (GT) 1b and SOF/VEL was not cost-effective.
Compared with other oral DAA agents, SOF/VEL treatment was not the most cost-effectiveness option for patients with chronic HCV GT1b in China. Lower the price of SOF/VEL will make it cost-effective while simplifying treatment and achieving the goal of HCV elimination.
本研究旨在评估在中国丙型肝炎病毒（HCV）患者中，索磷布韦/维帕他韦（SOF/VEL）相较于其他直接抗病毒药物（DAA）的成本效益。
建立马尔可夫模型，从医疗保健系统的角度估计HCV患者一生的疾病进展。疗效、临床数据和效用值均来自已发表的文献。药物成本来自市场价格调查，马尔可夫健康状态的健康成本来自一项中国研究。成本和效用值按每年5%的贴现率进行贴现。进行单向和概率敏感性分析，以测试输入参数对结果的影响。
将SOF/VEL与索磷布韦+利巴韦林（SR）、索磷布韦+达沙布韦（SD）、达拉他韦+阿舒瑞韦（DCV/ASV）、奥比他韦/帕利哌韦/利托那韦+达沙布韦（3D）以及艾尔巴韦/格拉瑞韦（EBR/GZR）进行比较。
成本、质量调整生命年（QALY）和增量成本效益比（ICUR）。
SOF/VEL在经济上优于SR和SD。然而，3D在经济上优于SOF/VEL。与DCV/ASV相比，SOF/VEL具有成本效益，ICUR为每QALY 1522美元。与EBR/GZR相比，其不具有成本效益，ICUR为每QALY 369627美元。单向敏感性分析表明，将SOF/VEL的成本降至置信区间下限会使其在经济上优于EBR/GZR和3D。概率敏感性分析表明，在100%的基因型（GT）1b患者迭代中，3D具有成本效益，而SOF/VEL不具有成本效益。
在中国，与其他口服DAA药物相比，SOF/VEL治疗并非慢性HCV GT1b患者最具成本效益的选择。降低SOF/VEL的价格将使其具有成本效益，同时简化治疗并实现消除HCV的目标。
