Revisiting policy on chronic HCV treatment under the Thai Universal Health Coverage: An economic evaluation and budget impact analysis

<div><p>Thailand is encountering challenges to introduce the high-cost sofosbuvir for chronic hepatitis C treatment as part of the Universal Health Care’s benefit package. This study was conducted in respond to policy demand from the Thai government to assess the value for money and budget impact of introducing sofosbuvir-based regimens in the tax-based health insurance scheme. The Markov model was constructed to assess costs and benefits of the four treatment options that include: (i) current practice–peginterferon alfa (PEG) and ribavirin (RBV) for 24 weeks in genotype 3 and 48 weeks for other genotypes; (ii) Sofosbuvir plus peginterferon alfa and ribavirin (SOF+PEG-RBV) for 12 weeks; (iii) Sofosbuvir and daclatasvir (SOF+DCV) for 12 weeks; (iv) Sofosbuvir and ledipasvir (SOF+LDV) for 12 weeks for non-3 genotypes and SOF+PEG-RBV for 12 weeks for genotype 3 infection. Given that policy options (ii) and (iii) are for pan-genotypic infection, the cost of genotype testing was applied only for policy options (i) and (iv). Results reveal that all sofosbuvir-based regimens had greater quality adjusted life years (QALY) gains compared with the current treatment, therefore associated with lower lifetime costs and more favourable health outcomes. Additionally, among the three regimens of sofosbuvir, SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype are the most cost-effective treatment option with the threshold of 160,000 THB per QALY gained. The results of this study had been used in policy discussion which resulted in the recent inclusion of SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype in the Thailand’s benefit package.</p></div

Efficacy of antiviral combination therapy for treatment of chronic HCV infection.

<p>Efficacy of antiviral combination therapy for treatment of chronic HCV infection.</p

Probabilities of treatment-associated anemia.

<p>Probabilities of treatment-associated anemia.</p

Cost-effectiveness plane of lifetime cost and effectiveness of four treatment strategies.

<p>Cost-effectiveness plane of lifetime cost and effectiveness of four treatment strategies.</p

Categories of structural chromosome abnormalities (SCA) and important assumptions used in the analysis.

<p>Categories of structural chromosome abnormalities (SCA) and important assumptions used in the analysis.</p

Results of costs and benefits from Strategy I and Strategy II under base-case assumptions.

<p>Results of costs and benefits from Strategy I and Strategy II under base-case assumptions.</p

Results of one-way sensitivity analysis of SOF+PEG-RBV (genotype 3) and SOF+LDV (non-3 genotype) compared to standard treatment (PEG-RBV regimen).

<p>Results of one-way sensitivity analysis of SOF+PEG-RBV (genotype 3) and SOF+LDV (non-3 genotype) compared to standard treatment (PEG-RBV regimen).</p

Results of one-way sensitivity analysis of SOF+PEG-RBV regimen compared to standard treatment (PEG-RBV regimen).

<p>Results of one-way sensitivity analysis of SOF+PEG-RBV regimen compared to standard treatment (PEG-RBV regimen).</p

Acceptability curves of the cost-effectiveness at the different ceiling threshold of four treatment strategies for chronic HCV infection.

<p>Acceptability curves of the cost-effectiveness at the different ceiling threshold of four treatment strategies for chronic HCV infection.</p

Decision tree of diagnostic strategies for the reduction of recurrent structural chromosome abnormalities in Thailand.

<p>Decision tree of diagnostic strategies for the reduction of recurrent structural chromosome abnormalities in Thailand.</p