Direct-acting antiviral treatment for hepatitis C can be
cost saving for some countries within five to ten years, especially if they can
negotiate lower drug prices, a study presented online at this month’s AASLD Liver Meeting
Madeline Adee of Massachusetts General Hospital Institute for
Technology Assessment presented results of a 158-country comparative study of
the cost-saving impact of direct-acting antiviral treatment for hepatitis C.
The World Health Organization’s goals for hepatitis C
elimination by 2030 challenge countries to diagnose 90% of people with
hepatitis C and treat 80% of people diagnosed with chronic hepatitis C over the
Some countries – including
Australia, the United Kingdom, Japan and Spain – are on course to achieve these goals before
2030 due to national planning, ambitious targets, well developed healthcare
infrastructure and drug price agreements that make treatment affordable. But
even so, only one in four higher-income countries will achieve hepatitis C
elimination by 2030 and lower- and middle-income countries are even further
To convince governments to invest in hepatitis C
elimination, policy makers must be persuaded that as well as reducing deaths and illness, hepatitis C treatment will eventually
achieve savings in healthcare costs. They also need to know what prices to aim
for in negotiations with pharmaceutical companies, as the prices paid for drugs
will influence the speed at which immediate treatment achieves future savings.
To assess when and at what price countries might achieve cost
savings by treating hepatitis C, the Institute for Technology Assessment
research team applied an existing model of hepatitis C disease progression to
epidemiological and healthcare costs for 158 countries. They compared the
impact of treatment to no treatment to identify what price paid for direct-acting
antivirals would achieve cost saving within five years.
Comparing countries, the study found that whereas treatment
higher-income countries (western Europe, North America, Australasia, South
Korea and Japan) would be cost saving within five years at a treatment cost
between $2001 and $9500 per treatment course, treatment in upper-middle-income
countries including Argentina, Chile, Mexico, Turkey, Russia and Malaysia would
need to be priced between $1001 and $2000 per course for the expenditure to be
cost saving within five years.
For China, Iran and Thailand – countries with a high prevalence
of hepatitis C – treatment would need to be priced between $501 and $1000 to be
cost saving. Several large middle-income countries with high burdens of
hepatitis C – Brazil, Egypt, India, Indonesia and Ukraine – would need to pay
between $150 and $500 for treatment to be cost saving.
Lower-income countries in sub-Saharan Africa and Pakistan
could expect treatment to be cost saving within five years only if they paid
less than $150 per treatment course.
Based on data supplied to the researchers, only eleven
countries have achieved direct-acting antiviral prices that would lead to treatment
being cost saving in five years, including Chile, Belarus, Kazakhstan, Ukraine,
India and Pakistan. Few countries had achieved prices that would enable
treatment to become cost saving within ten years.
In the majority of countries that supplied price data,
treatment would become cost saving over the lifetime of the treated individual,
but in high-income countries and the countries with the lowest incomes, the prices
reported for direct-acting antiviral treatment are so high, the costs of treatment
will never be recouped by other savings on health care.
The study also looked at the impact of dramatic reductions
in the cost of direct-acting antivirals. If the cost of a treatment course fell
to $90, it would take between 1.5 years and 17.2 years for treatment to become
cost saving in lower-income countries. In higher-burden lower-middle-income
countries, treatment at this price would be cost saving within three years.