Model shows hepatitis C treatment is cost-effective in Japan

Treatment of chronic hepatitis C with direct-acting antivirals (DAAs) can lead to substantial savings by preventing the development of liver failure and liver cancer, according to a mathematical modelling study presented at the AASLD Liver Meeting last month in Washington, DC.

Over years or decades chronic hepatitis C virus (HCV) infection can lead to serious liver disease including cirrhosis (scarring of the liver), hepatocellular carcinoma (HCC; a type of primary liver cancer) and decompensated liver disease (when the liver can no longer carry out its vital functions).

The advent of DAAs has made hepatitis C treatment shorter, better tolerated and much more effective compared with the old interferon-based therapy. Successful hepatitis C treatment can halt liver disease progression, but it cannot always fully reverse existing liver damage. People who already have cirrhosis when they start treatment remain at risk for liver cancer even after being cured.

But hepatitis C treatment is expensive, so policymakers and insurance providers want evidence that it will break even or save money on other care over the long run, known as cost-effectiveness.

Zobair Younossi of Inova Fairfax Hospital in Virginia and colleagues developed a mathematical model to estimate the economic benefits of curing hepatitis and thereby reducing the occurrence of liver cancer and decompensated cirrhosis in Japan. Liver cancer is a leading cause of death in Japan, with around 70% of cases attributable to HCV infection.

Compared with many other countries, where HCV infection is most common among 'baby boomers' (as in the US) or younger people who inject drugs, HCV prevalence in Japan is higher among older people, Younossi explained as background. Many elderly people with hepatitis C were infected decades ago (likely due to unsterile medical equipment) and have had more time to develop advanced liver disease. In contrast, people with chronic hepatitis C in Europe and the US are at an earlier stage of disease, on average, and have not yet developed as many complications.

Younossi's model considered a hypothetical cohort of 10,000 Japanese people with an average age of 60 who had chronic HCV genotype 1b infection (the most common type in Japan). The model assumed that 15% of the group had progressed to cirrhosis and that 20% had tried previous treatment.

The model compared treatment using any approved interferon-free DAA regimen versus no treatment. Efficacy was assumed to be similar to that seen in randomised clinical trials – greater than 95% for easy-to-treat genotype 1b. The model was used to compare the number of cases of decompensated cirrhosis and HCC avoided – and their associated cost – as well as the number of quality-adjusted life years gained for treated and untreated people.

DAA treatment prevented 1495 cases of decompensated cirrhosis, saving ¥341,645 per treated patient, as well as 2078 cases of HCC, saving ¥857,946 per patient. Together, treatment prevented 3573 cases of both of these hepatitis C complications, saving ¥1,199,592 per patient, equivalent to about £8061, €9013 or US$10,754.

In addition to these direct savings from avoiding the cost of care for advanced liver disease, DAA treatment also led to gain of 2.67 quality-adjusted life years per patient, with an indirect economic benefit ranging from ¥10,680,000 to ¥16,020,000 per patient.

Altogether, the total economic savings of treatment with DAAs compared to no treatment ranged from ¥11,879,592.6 to ¥17,219,592 (about £115,718, €129,381 or US$154,373 at the high end).

Based on these findings, Younossi's team concluded, "Treatment of HCV genotype 1 with all-oral DAAs in Japan can lead to significant direct and indirect savings related to avoidance of HCC and decompensated cirrhosis."