Cost‐effectiveness of generic sofosbuvir/velpatasvir versus genotype‐dependent direct‐acting antivirals for hepatitis C treatment

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Cost‐effectiveness of generic pan‐genotypic sofosbuvir/velpatasvir versus genotype‐dependent direct‐acting antivirals for hepatitis C treatment
Amit Goel Qiushi Chen Jagpreet Chhatwal Rakesh Aggarwal
First published: 04 June 2018 https://doi.org/10.1111/jgh.14301

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Abstract
Background
Treatment of HCV infection with low‐cost generic direct‐acting antivirals (DAAs) available in India and other developing countries needs determination of HCV genotype (‘genotype‐dependent' regimens). Generic velpatasvir, a DAA that obviates the need for genotype determination (‘pan‐genotypic' regimen) recently became available but is costlier.

Aim
To evaluate the cost‐effectiveness of genotype‐dependent versus pan‐genotypic DAA treatments in India.

Methods
A previously‐validated microsimulation model, adapted to Indian population, was used to compare the costs and long‐term outcomes of three scenarios: no treatment, and treatment with genotype‐dependent and pan‐genotypic regimens. Input parameters were derived from literature. Using a payer's perspective and life‐time time horizon, quality‐adjusted life years (QALYs), total costs, and incremental cost‐effectiveness ratio (ICER) were calculated. Both deterministic and probabilistic sensitivity analyses were also conducted.

Results
At the current price (US$ 223 for 4 weeks), pan‐genotypic regimen was cost‐saving compared to no treatment. Compared with genotype‐dependent regimens, it increased QALYs by 0.92 and increased costs by US$ 107, but was deemed cost‐effective with an ICER of US$ 242 per QALY gained. Probabilistic sensitivity analysis also supported the cost‐effectiveness of pan‐genotypic regimen. At the reduced price of US$ 188 for 4 weeks, the pan‐genotypic regimen will become cost‐neutral to genotype‐dependent regimens (current price: US$100 for 4 weeks).

Conclusions
At current prices, velpatasvir‐based pan‐genotypic regimen is cost‐effective for HCV treatment in India where generic drugs are available. A reduction in the prices of pan‐genotypic regimen has the potential to make its use cost‐saving, while simplifying treatment in community‐level programs aimed at HCV elimination.
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