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Until 2011, the combination of pegylated interferon (pINF) and ribavirin (RBV) for 24 or 48 weeks was the approved treatment for chronic hepatitis C (CHC). Telaprevir and boceprevir, licensed in 2011 for use in patients infected with HCV genotype 1, were the first direct-acting antiviral agents (DAAs). With combinations including these agents, higher sustained viral response (SVR) rates were achieved compared with pINF+RBV, but also higher side effects. In 2013, sofosbuvir (SOF) was approved for use in HCV-infected patients with genotypes 2 and 3 in combination with RBV, and in those with genotypes 1 and 4, in combination with pINF and RBV with SVR rates >90%.1 ,2 With approval of other oral DAAs such as simeprevir and daclatasvir, now highly efficacious interferon-free regimens are also prescribed, particularly in genotypes 1 and 4.3 ,4 Moreover, last week, the European Commission granted marketing authorisation for the SOF–ledipasvir combination (Harvoni), the first single-tablet interferon-free regimen to treat HCV-infected patients with genotypes 1 and 4.5
This new wave of antiviral therapy for CHC holds great promise with SVR rates >90%, better tolerability and shorter treatment duration. However, they are also accompanied by a significant increase in the cost of treatment regimens. As resources are limited, particularly in the time of crisis, it is important to assess, along with the already proven efficacy, the cost-effectiveness of these new drugs to treat CHC. The cost-effectiveness analysis allows us to explicitly consider whether the additional benefit from a more effective but more expensive strategy is ‘worth’ the additional cost. …
Contributors SD-B and YY participated in writing the paper, drafted the word and approved the final version to be published.
Competing interests SD-B has received research grants from Roche, Janssen and Schering-Plough/Merck, and consultancy honoraria from Abbott, Abbvie, Bristol-Myers Squibb, Glaxo Smith Kline, HEVA, Janssen, Schering-Plough/Merck and Public Health Expertise. YY has received travel grants, lecture fees and consulting honoraria from Abbott/Abbvie, Bristol-Myers Squibb Gilead, Roche, Schering-Plough/Merck, Tibotec and ViiV Healthcare.
Provenance and peer review Commissioned; internally peer reviewed.