Generic Direct-acting Antivirals for HCV Prove Effective, Cost-saving in India Study

Treating patients with hepatitis C virus (HCV) with generic directing acting antivirals (DAAs) leads to improved outcomes and cost savings, according to the results of a recent study conducted in India. The study was led by Rakesh Aggarwal of Sanjay Gandhi Postgraduate Institute of Medical Sciences, located in Lucknow, India.

There are between 6 and 11 million people with HCV in India. In 2015, approximately 59,000 residents died from the virus. Although DAAs are both convenient and extremely effective, they are expensive, and access is limited.

Three DAAs — sofosbuvir, ledipasvir, and daclatasvir — are available in generic form at a greatly reduced cost. The authors of the study noted that despite this, treatment rates remain very low in India. They added that lack of data regarding the cost-effectiveness of generic DAAs and a limited budget for HCV treatment contribute to the low rates.

The researchers wrote that it is expected DAAs will be cost effective, but it is not known how long it would take for the drugs to become cost-effective, nor is it known whether or not DAAs would also be cost-saving by increasing life expectancy and decreasing costs.

“We therefore estimated the cost-effectiveness of treatment of HCV-infected persons in India using low-priced DAAs, and evaluated if/when the upfront cost of treatment for HCV infection could result in cost savings,” the authors wrote.

In order to carry out the study, the researchers used a model they had previously developed and validated, called the Markov-based Analyses of Treatments for Chronic Hepatitis C (MATCH), which they adapted for the HCV patient population in India.

The researchers based their base case population on the available data regarding HCV infection in India. They defined a total of 30 unique patient profiles “based on HCV genotype and the patient’s sex, and METAVIR fibrosis score”. Patients with HIV or hepatitis B co-infection were excluded, as well as those who were at a higher risk of reinfection.

Medical costs were considered from a healthcare payer’s point of view. The researchers noted that many Indian patients lack financial resources, do not have access to specialized care, and “because we wanted our model to represent a conservative scenario by underestimating the savings resulting from DAA use”.

They additionally weighed for quality-adjusted life years (QALYs) and disability adjusted life years (DALYs).

After millions of iterations, the researchers estimated that they use of DAAs would increase the overall life expectancy of HCV patients by 8.02 years and discounted QALYs by 3.89.

The no-treatment group had a lifetime cost of $1,988 per person, but the DAA arm had a cost of $679. In other words, “antiviral treatment in India was found to be cost-saving, i.e., it increased QALYs by 3.89 years while simultaneously decreasing total healthcare costs by $1,309,” the authors wrote.

Treatment with DAAs was cost-effective within two years, and cost-saving in 10 years.

Previous analyses of the cost effectiveness of DAAs focused on treatment in countries where the drugs are more expensive. Even with the higher costs, DAAs were found to be cost-effective. Still, DAAs are used less often than expected due to cost. The present study shows that use of less-expensive generic DAAs in India is both cost effective and cost-saving.

“In conclusion, we found that low-cost generic DAAs available in India can improve patient outcomes and also result in cost-savings in a fairly short time-frame,” the authors wrote. They further suggest that these results should be a priority, not only in India, but in other countries where generic, less-expensive DAAs are available.

The study, “Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India,” was published online in the journal PLOS One.

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