Economic Evaluation Of Direct-Acting Antivirals In The Treatment Of Chronic Hepatitis C

BackgroundHepatitis C is one of the main causes of liver cirrhosis and liver cancer.China has the largest number of chronic hepatitis C patients around the world.There are about 10 million chronic hepatitis C patients,causing serious public health problems.At present,there are many kinds of direct antiviral drugs(DAAs)on the market in China.These drugs can effectively treat hepatitis C,but the price is expensive,which brings huge economic burden to patients.In order to allocate resources reasonably and effectively,clinical drug selection should not only consider the efficacy of drugs,but also consider its economy.In the national health insurance negotiation in 2019,three DAAs for treating hepatitis C will be included in the national class B health insurance catalogue.Under the limited budget of the health insurance fund,it is necessary to predict the impact of DAAs on the fund after they are included in the health insurance,so as to judge the affordability of DAA drugs.ObjectiveThis study aimed to evaluate the economy of direct antiviral drugs based on Markov model,so as to provide reference for clinicians and patients to choose drug therapy;Taking Jinan City as an example,budget impact analysis was to predict the impact of DAAs on the fund after being included in the medical insurance,and provides relevant decision-making basis for medical insurance institutions.Methods1.Markov model analysis:The disease states,transition probabilities,utilities,clinical efficacy and other model parameters of Markov model were obtained from literature,the cost parameters were from the drug market price and the charging standard of a third-class hospital in Jinan;Markov model was built to simulate the long-term treatment cost and health outcome of various treatment schemes,so as to calculate the Incremental cost-effectiveness ratio.2.Budget impact analysis:The target population and market share were derived from epidemiological data and expert advice,combined with drug cost,the budget impact model was built to predict the impact of direct antiviral drugs(DAAs)on the medical insurance fund after being included in the medical insurance catalog,so as to evaluate the affordability of medical insurance fund for DAAs.Results1.Markov simulation results(1)Cost-effectiveness analysis:At the willing to pay threshold of 212676 yuan/QALY,for gene lb hepatitis C,3D is the most economical treatment therapy;for gene 2,3,6 patients,SOF/VEL is the most economical treatment at present.(2)Sensitivity analysis:The parameters that affect the incremental cost effectiveness ratio(ICER)are the price of the drug,the clinical efficacy and the utility after the achievement of SVR.(3)Scenario analysis:LDV/SOF has become the most cost-effective option in patients with genotype 1b after medical insurance negotiation price reduction;for patients with genotype 2,3 and 6,SOF/VEL is more economical than other options after price reduction.2.Budget impact analysisCompared with that DAAs was not included in the medical insurance,when DAAs is included in the medical insurance,the increase of medical insurance fund expenditure from 2020 to 2024 was RMB 1.465 million,RMB 1.512 million,RMB 1.5354 million,RMB 1.5716 million,and RMB 1.678 million respectively;In five years,the accumulative increase of medical insurance fund expenditure was RMB 7.681 million,with an increase of 89.59%.At the same time,100%of the insured patients can enjoy the economic share of medical insurance reimbursement,compared with 21%of the patients before DAAs was included in the medical insurance,and the number of patients who benefit from DAAs after it was included in the medical insurance increased by 79%.Sensitivity analysis shows that DAAs medical insurance payment standard has great influence on the result of budget impact analysisConclusionBefore the medical insurance negotiation,the most cost-effective scheme for Genotype 1b hepatitis C was 3D therapy;for Genotype 2,3 and 6,the most cost-effective scheme was SOF/VEL.After medical insurance negotiation and price reduction,LDV/SOF is the most economical therapy for GT 1b;for GT 2,3 and 6,SOF/VEL is the most economical drug.The budget impact analysis shows that after the DAAs was included in the national health insurance catalogue,the expenditure of Jinan health insurance fund increases at a relatively low level,while benefiting a large number of patients.