Fig 3 -

The Predicted distribution of risk scores of CHDs (A) in 2012, (B) Predicted for 2021 in the Scenario without CHAP, and (C) with CHAP. Low1, ≤35; Low2, 36–40; Middle1, 41–45; Middle2, 46–50; Middle3, 51–55; High1, 56–60; High2, 61–65; High3, ≥66.</p

The trend of patient characteristics, risk factors, and risk scores.

The trend of patient characteristics, risk factors, and risk scores.</p

Factors related to changes in risk scores after the removal of cases with missing records.

(DOCX)</p

Fig 4 -

The Predicted distribution of risk scores of stroke (A) in 2012, (B) Predicted for 2021 in the Scenario without CHAP, and (C) with CHAP.</p

Estimated number of incidences and medical costs in 10 Years after 2021.

Estimated number of incidences and medical costs in 10 Years after 2021.</p

Factors related to risk scores.

Factors related to risk scores.</p

The trend of risk scores.

Error bars indicate 95% confidential intervals. (A) CHDs and (B) Stroke.</p

Fig 1 -

(A) Location of Aomori Prefecture, Hirosaki City (light blue), and Iwaki District (blue). (B) The Period and Coverage of Iwaki Cohort Data. Iwaki district is located in Aomori Prefecture, and Iwaki cohort data contains checkup results before and after the start of CHAP. CHAP = Center of Healthy Aging Program.</p

Risk score to estimate the 10-year incidence risk of CHDs and stroke.

(DOCX)</p

Cost–utility analysis of ledipasvir/sofosbuvir for the treatment of genotype 1 chronic hepatitis C in Japan

<p><b>Objective:</b> Hepatitis C is the result of a ribonucleic acid (RNA) virus (hepatitis C virus; HCV). The Japan Society of Hepatology (JSH) estimated that 1.5–2 million people in Japan carry HCV. Six major HCV genotypes (GT) and a large number of subtypes have been described in the literature. In Japan, around 70% to 80% of people are infected with HCV genotype 1b. The progress of the disease primarily affects the liver and may lead to liver cirrhosis, hepatocellular carcinoma (HCC) and death. Sofosbuvir (SOF) is a nucleotide analogue NS5B inhibitor and ledipasvir (LDV) is an inhibitor of the HCV NS5A protein. They are combined in a single tablet regimen for the treatment of GT1 patients and resulted in sustained virological response (SVR) above 94% in large phase III trials. This analysis assesses the cost–utility of LDV/SOF in GT1 patients in Japan.</p> <p><b>Research design and methods:</b> A cohort of 10,000 patients was followed through a Markov model until they reached 100 years of age. GT1 treatment-naïve and experienced, non-cirrhotic and cirrhotic patients were studied separately. LDV/SOF was compared to several treatment regimens containing pegylated interferon (PEGIFN), telaprevir (TVR), simeprevir (SMV), daclatasvir (DCV), asunaprevir (ASV) and ribavirin (RBV). Discount rates of 2% were applied to costs and outcomes according to the Japanese guidelines.</p> <p><b>Results:</b> LDV/SOF was cost-effective against most comparators with incremental cost-effectiveness ratios (ICERs) below JPY 5,000,000. By applying a societal perspective, LDV/SOF was the dominant treatment strategy in all cases. Moreover, LDV/SOF reduced the number of cases of advanced liver disease. These results were robust to sensitivity analyses.</p> <p><b>Conclusions:</b> LDV/SOF was cost-effective compared to most of the currently recommended treatments. Furthermore, LDV/SOF extends treatments to HCV-infected patients who are ineligible for interferon and RBV-based regimens. LDV/SOF thus has the potential to help reduce the burden of HCV in Japan.</p