Developing a patient-driven cost-effectiveness analysis of pharmacological treatments for patients with chronic hepatitis C

Abstract

Background: Innovations in hepatitis C virus (HCV) drug therapy included in comparative clinical effectiveness evaluations focus on sustained virologic response (SVR) without consideration of socioeconomic or psychological outcomes. This study aimed to identify and prioritize variables important to patients and determine the impact of patient-centered parameters on the cost effectiveness of HCV treatments.

Methods: An individual-based state-transition model was developed with the guidance of a patient-centered multi-stakeholder advisory board and patient-only Delphi panel. The model was used to perform a patient-driven cost-effectiveness analysis (CEA) of direct acting antivirals (DAAs) over 10 and 20 year time horizons from both health sector and societal perspectives. The patient-centered model and CEA results were then compared with recently published HCV CEAs.

Results: Patients identified treatment effectiveness, longer life, fear of complications, financial issues, quality of life, and impact on society as important factors to include. Fear of harming others was considered more important than physical symptoms in terms of patient-reported problems caused by HCV. Total infected life-years (ILYs) and work days missed were reduced in the treatment group for both 10 and 20 year health sector models in addition to quality-adjusted life-year gains. Compared to no treatment, the incremental cost-effectiveness ratio for treatment would be $3,464/ILYs avoided, $715/work day missed, and $39,086/QALY gained. When costs of absenteeism, presenteeism, and patient/caregiver time were included, the DAA intervention was cost-saving at both 10 and 20 years. Very few traditional economic models for HCV treatments attempt to capture the indirect and non-medical costs or outcomes that may impact HCV patients.

Conclusions: Treatment was cost-effective from a health sector perspective and cost-saving when including non-health costs such as patient/caregiver time and productivity. Compared to published HCV CEAs that focused mainly on SVR, our patient-centered CEA provides results that reflect the outcomes of interest informed by direct patient engagement.