Cost-effectiveness Analysis Of Novel Direct-acting Antivirals In The Treatment Of Chronic Hepatitis C In China Based On Markov Model

Nowadays,chronic diseases have become the "number one killer" threatening human health.The communist party and the state attach increasing importance to the people’s health.In October 2016,the central committee of the communist party of China and the state council issued the outline of the "healthy China 2030" plan,which clearly stated that the goal of significantly reducing the premature death rate from major chronic diseases should be achieved in the field of health services and social security.In chronic diseases,chronic hepatitis C has already become the common chronic infectious disease after hepatitis B,which caused the major diseases such as liver cirrhosis and hepatocellular carcinoma and brought about the patient’s premature death successively.At present,pegylated interferon α combined with ribavirin(PR)is the standard regimen for chronic hepatitis C in China,but PR regimen has poor efficacy and severe side effects for patients.Since April 2017,multiple direct-acting antivirals(DAAs)with better efficacy and safety have approved by China Food and Drug Administration for the treatment of patients with chronic hepatitis C in China,but the cost of DAAs is pretty high.Whether all DAAs regimens are more cost-effective than PR regimen,as well as which DAAs regimen is the most cost-effective alternative,all these are lack of corresponding research.A Markov model was constructed based on the natural history of chronic hepatitis C to simulate the lifetime(100 years of age)health benefits and direct medical costs for patients with chronic hepatitis C from the health care system perspective among all the therapeutic regimens through literature research method,model method and statistical analysis method.one year cycle length was adopted,and a 5% discount rate was applied to both health benefits and costs.Based on the simulation results,this research compared the differences in the long-term survival rate,end-stage liver disease events incidence and medical costs for all the therapeutic regimens,and then incremental cost-effectiveness ratio was used to explore the cost-effectiveness of DAAs regimens compared with no treatment and PR regimen,and the most cost-effectiveness alternative of all DAAs regimens.Uncertainty analysis methods including one-way sensitivity analysis,probabilistic sensitivity analysis and situation analysis were applied to perform the robustness test of research results.Research analyses showed that six DAAs regimens not only improved the long-term survival rate and reduce the incidence of end-stage liver disease events,but also reduced medical costs compared with no treatment and PR regimen,all DAAs regimens are all the cost-effective regimens.Among all the DAAs regimens,the combination of paritaprevir/ombitasvir/ritonavir + dasabuvir ± ribavirin was the most cost-effective alternative for all the target population at current drug prices.The above findings were confirmed by the uncertainty analyses.The results showed that the relevant departments should strengthen the public awareness of chronic hepatitis C and its therapeutic drugs,and establish the screening mechanism of chronic hepatitis C to achieve early diagnosis and treatment of patients.At the same time,DAAs agents such as paritaprevir/ombitasvir/ritonavir + dasabuvir ± ribavirin should be included into the basic medical insurance reimbursement as soon as possible,and a special relief fund project for chronic hepatitis C should be considered to ensure the availability of effective therapeutic drugs for all patients with chronic hepatitis C.