Cost-effectiveness analysis of sofosbuvir compared to current standard treatment in Swiss patients with chronic hepatitis C

PLoS One. 2015 May 14;10(5):e0126984. doi: 10.1371/journal.pone.0126984. eCollection 2015.

Abstract

In clinical trials, sofosbuvir showed high antiviral activity in patients infected with hepatitis C virus (HCV) across all genotypes. We aimed to determine the cost-effectiveness of sofosbuvir-based treatment compared to current standard treatment in mono-infected patients with chronic hepatitis C (CHC) genotypes 1-4 in Switzerland. Cost-effectiveness was modelled from the perspective of the Swiss health care system using a lifetime Markov model. Incremental cost-effectiveness ratios (ICERs) used an endpoint of cost per quality-adjusted life year (QALY) gained. Treatment characteristics, quality of life, and transition probabilities were obtained from published literature. Country-specific model inputs such as patient characteristics, mortality and costs were obtained from Swiss sources. We performed extensive sensitivity analyses. Costs and effects were discounted at 3% (range: 0-5%) per year. Sofosbuvir-containing treatment in mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 showed ICERs between CHF 10,337 and CHF 91,570 per QALY gained. In subgroup analyses, sofosbuvir dominated telaprevir- and boceprevir-containing treatment in treatment-naïve genotype 1 cirrhotic patients. ICERs of sofosbuvir were above CHF 100,000 per QALY in treatment-naïve, interferon eligible, non-cirrhotic patients infected with genotypes 2 or 3. In deterministic and probabilistic sensitivity analyses, results were generally robust. From a Swiss health care system perspective, treatment of mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 with sofosbuvir-containing treatment versus standard treatment would be cost-effective if a threshold of CHF 100,000 per QALY was assumed.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / economics*
  • Antiviral Agents / therapeutic use
  • Cost-Benefit Analysis
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / economics*
  • Hepatitis C, Chronic / epidemiology
  • Humans
  • Markov Chains
  • Quality of Life
  • Quality-Adjusted Life Years
  • Sofosbuvir / economics*
  • Sofosbuvir / therapeutic use
  • Switzerland / epidemiology

Substances

  • Antiviral Agents
  • Sofosbuvir

Grants and funding

The study was funded by Gilead Switzerland. The sponsor participated, but did not make final decisions regarding the design, conduct or reporting of the study and had no role in data collection and analysis, decision to publish, or preparation of the manuscript. Helsana Group and OPTUMInsight provided support in the form of salaries for the authors OR, IMG, and SC, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the "author contributions" section.