Pharmacoeconomic Evaluation Based On Markov Model For Treatment Of Chronic Hepatitis C In China

With the increase of medical expenses of chronic hepatitis C, how to allocate the limited health resources reasonably is very important. Researchers not only consider efficacy and safety of treatment regimens, but also evaluate the balance between lifetime cost and effectiveness in decision making. Currently, simeprevir has been listed in Japan and clinical trials based on Chinese patients have also been accomplished. It will be listed in China in the near future. And along with more and more novel regimens of chronic hepatitis C coming into China, it is important to choose the most economical and effective treatment regimen. Our study is to establish appropriate Chinese economic model based on Markov model for treatment of chronic hepatitis C and estimate cost-effectiveness of different treatment regimens. This study worked as a reference for subsequent researches.The main contents are as follows:(1) Transition states and progression of Markov model were determined according to natural history of chronic hepatitis C. Markov model was developed using Microsoft Excel and model validation was also conducted based on the inputs sourced from published literature.(2) Inputs were confirmed according to different researches, including sample size and characteristics of cohort, transition probability, treatment effectiveness, weekly cost of drug or virus detection, annual cost and utility value of health states.(3) Lifetime cumulative costs and QALYs of each treatment regimen were simulated to estimate cost-effectiveness of interferon-based regimen and simeprevir regimen. The listed price and efficacy of simeprevir in Japan worked as a reference.(4) Subgroup analysis and Sensitivity analysis were conducted to evaluate uncertainty. Particularly, cost-effectiveness of simeprevir regimen compared with peginterferon regimen was estimated under different weekly drug cost and efficacy.(5) In consideration of unavailability of simeprevir at present, cost-effectiveness of delaying treatment for simeprevir regimen in the subsequent five years was estimated compared with peginterferon regimen.The main results are as follows:(1) Base-case analysis:At a willingness-to-pay threshold of 139593 ￥/QALY, patients treated with interferon regimen increased 1.44 QALY and saved lifetime cost of ￥48320 compared with no treatment; patients treated with peginterferon regimen increased 1.16 QALY and saved lifetime cost of￥11560 compared with interferon regimen; patients treated with simeprevir regimen increased 0.55 QALY and saved lifetime cost of ￥16259 compared with peginterferon regimen.(2) Sensitivity analysis:ICER was sensitive to SVR rate, weekly drug cost and utility after achieving SVR. And compared with reference regimen, all the regimens had a likelihood of ≥95% being cost-effective at a willingness-to-pay threshold of 139593 ￥/QALY. In addition, with the assumption of SVR rate of 85%, simeprevir regimen remained cost-effective even if weekly drug cost increased to ￥11000.(3) Scenario analysis:Patients initiating simeprevir regimen in the 1st (2nd) year resulted in a positive NB of ￥67379 (￥36075). Particularly, patients diagnosed at F1 or F2 remained cost-effective in the next five years.