Hepatitis C cost-effectiveness of therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rebecca Cohen


Treatment of patients with Hepatitis C virus (HCV) has evolved considerably in the recent past. In terms of cost-effectiveness, initially a dual-treatment regimen of peginterferon alfa and ribavirin was favored. This regimen recommendation was then replaced by the triple-treatment strategy with the introduction of boceprevir and telaprevir. Now the FDA approval of interferon-free treatments such as Sofosbuvir, Ledipasvir, and Viekira Pak has given patients more treatment options. Despite the high economic cost of these new drugs, they display low rates of adverse events and may ultimately represent cost-effective treatment options because of the benefits they can offer HCV patients.

Cost effectiveness of therapy

Old treatment methods included a dual-treatment regimen of peginterferon alfa and ribavirin, and then with the development of similar drugs boceprevir and telaprevir, a triple-therapy treatment strategy was introduced, though these triple therapy regimens showed high rates of discontinuation of use because of adverse events.

Sofosbuvir, approved by the FDA in 2013, used in combination with the old standard of treatment was found to be more effective that the old standard of treatment alone [1]. Sofosbuvir is more expensive than previous forms of therapy, but it was effective in genotype 1 [1] [2] and genotype 2 and 3 individuals [3] and could ultimately translate into savings by reducing the incidence of other liver-disease related costs. Moreover, Sofosbuvir has been shown to be an effective treatment regimen for patients with cirrhosis or individuals who were previously treated with but did not see benefits from interferon [3].

However, Sofosbuvir was not a cost effective treatment for naïve non-cirrhotic patients with genotype 2 or 3 for who are candidates for pegylated interferon-ribavirin treatment, as they exceed the typical cost-effective threshold for quality adjusted life years (QALY) (over $100000 per QALY) [3].

It should be noted that HCV-infected patients do not always develop cirrhosis, and are at low risk of death from HCV until this event. For this reason, at its current high price Sofosbuvir may be a good option in terms of cost-effectiveness for treatment-experienced patients, especially those with cirrhosis [3].

Two new interferon-free drugs, Harvoni (which contains Sofosbuvir and Ledipasvir) and Viekira Pak, were approved for treatment of genotype 1 HCV patients. With competition, these drugs may help reduce the price of hepatitis C treatment and increase the cost effectiveness per QALY and increase HCV patient access to care.


  1. 1.0 1.1 Saab S, Gordon SC, Park H, Sulkowski M, Ahmed A, Younossi Z (2014). "Cost-effectiveness analysis of sofosbuvir plus peginterferon/ribavirin in the treatment of chronic hepatitis C virus genotype 1 infection". Aliment Pharmacol Ther. 40 (6): 657–75. doi:10.1111/apt.12871. PMID 25065960.
  2. Chhatwal J, Kanwal F, Roberts MS, Dunn MA (2015). "Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States". Ann Intern Med. 162 (6): 397–406. doi:10.7326/M14-1336. PMC 4435698. PMID 25775312.
  3. 3.0 3.1 3.2 3.3 Linas BP, Barter DM, Morgan JR, Pho MT, Leff JA, Schackman BR; et al. (2015). "The cost-effectiveness of sofosbuvir-based regimens for treatment of hepatitis C virus genotype 2 or 3 infection". Ann Intern Med. 162 (9): 619–29. doi:10.7326/M14-1313. PMC 4420667. PMID 25820703.

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