Treatment of hepatitis C virus leads to economic gains related to reduction in cases of hepatocellular carcinoma and decompensated cirrhosis in Japan

摘要

Summary Hepatocellular carcinoma ( HCC ) is a serious complication of hepatitis C virus ( HCV ) infection. Sustained virologic response ( SVR ) for HCV is associated with a reduction in cirrhosis, HCC and mortality and their associated costs. Japanese HCV patients are older with higher prevalence of HCC . Here we used a decision‐analytic Markov model to estimate the economic benefit of HCV cure by reducing HCC and DCC burden in Japan. A cohort of 10?000 HCV genotype 1b ( GT 1b) Japanese patients was modelled with a hybrid decision tree and Markov state‐transition model capturing natural history of HCV over a lifetime horizon. Treatment options were approved all‐oral direct‐acting anti‐virals ( DAA s) vs no treatment. Treatment efficacy was based on clinical trials and transition rates and costs obtained from Japan‐specific data. Cases of HCC , decompensated cirrhosis ( DCC ) and quality‐adjusted life years ( QALY s) were projected for patients treated with DAA s vs NT . QALY s were monetized using a willingness‐to‐pay threshold of ￥4‐to‐￥6 million. Incremental savings with treatment were calculated by adding the projected cost of complications avoided to the monetized gains in QALY s. The model showed that DAA treatment vs no treatment, reduces 2057 cases of HCC and 1478 cases of decompensated cirrhosis and saves ￥850?446.73 and ￥338?229.90 per patient (ppt). Additionally, treatment can lead to additional 2.64 QALY s gained per patient. The indirect economic gains associated with treatment‐related QALY improvements were ￥10?576?000, ￥13?220?000 and ￥15?864?000 ppt (willingness‐to‐pay thresholds of ￥4 million, ￥5 million and ￥6 million). Total economic savings of treatment with DAA s (vs no treatment) was ￥7?526?372.63, ￥10?170?372.63 and ￥12?814?372.63, at these different willingness‐to‐pay thresholds. In conclusion treatment of HCV GT 1b with all‐oral DAA s in Japan can lead to significant direct and indirect savings related to avoidance of HCC and DCC .