Economic Evaluation and HTA, Centre for Economic and International Studies, (EEHTA-CEIS) Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.
Institute of Leadership and Management in Health, Kingston Business School, Kingston Univeristy, London, UK.
Liver Int. 2021 May;41(5):934-948. doi: 10.1111/liv.14808. Epub 2021 Feb 24.
We assessed the clinical and economic impact of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) in England, Italy, Romania and Spain.
An HCV progression Markov model was developed considering DAA eligibility and population data during the years 2015-2019. The period of time to recover the investment in DAAs was calculated as the cost saved by avoiding estimated clinical events for 1000 standardized treated patients. A delayed treatment scenario because of coronavirus disease (COVID-19) was also developed.
The estimated number of avoided hepatocellular carcinoma, decompensated cirrhosis and liver transplantations over a 20-year time horizon was: 1,057 in England; 1,221 in Italy; 1,211 in Romania; and 1,103 in Spain for patients treated during 2015-2016 and 640 in England; 626 in Italy; 739 in Romania; and 643 in Spain for patients treated during 2017-2019. The cost-savings ranged from € 45 to € 275 million. The investment needed to expand access to DAAs in 2015-2019 is estimated to be recovered in 6.5 years in England; 5.4 years in Italy; 6.7 years in Romania; and 4.5 years in Spain. A delay in treatment because of COVID-19 will increase liver mortality in all countries.
Direct-acting antivirals have significant clinical benefits and can bring substantial cost-savings over the next 20 years, reaching a Break-even point in a short period of time. When pursuing an exit strategy from strict lockdown measures for COVID-19, providing DAAs should remain high on the list of priorities in order to maintain HCV elimination efforts.
我们评估了直接作用抗病毒（DAA）疗法在英格兰、意大利、罗马尼亚和西班牙治疗丙型肝炎病毒（HCV）的临床和经济影响。
我们开发了一个 HCV 进展的 Markov 模型，考虑了 DAA 的适应证和 2015-2019 年的人口数据。通过避免估计的 1000 名标准化治疗患者的临床事件来计算收回 DAA 投资所需的时间。还制定了因冠状病毒病（COVID-19）而延迟治疗的方案。
在 20 年的时间内，预计可避免的肝细胞癌、失代偿性肝硬化和肝移植的数量为：英格兰为 1057 例；意大利为 1221 例；罗马尼亚为 1211 例；西班牙为 1103 例，这些患者是在 2015-2016 年接受治疗的；英格兰为 640 例；意大利为 626 例；罗马尼亚为 739 例；西班牙为 643 例，这些患者是在 2017-2019 年接受治疗的。节省的成本从 4500 万到 2.75 亿欧元不等。在英格兰，扩大 2015-2019 年 DAA 可及性所需的投资预计将在 6.5 年内收回；意大利为 5.4 年；罗马尼亚为 6.7 年；西班牙为 4.5 年。由于 COVID-19 而延迟治疗将增加所有国家的肝脏死亡率。
直接作用抗病毒药物具有显著的临床获益，并可在未来 20 年内带来大量的成本节省，在短时间内达到收支平衡。在为 COVID-19 采取严格封锁措施后，为维持 HCV 消除工作，提供 DAA 应继续作为优先事项。
