Cost-effectiveness analysis of strategies to manage the disease burden of hepatitis C virus in Switzerland

BACKGROUND AND AIMS: A previous analysis of hepatitis C virus (HCV)-related healthcare costs in Switzerland found that the annual healthcare costs of untreated HCV infection (excluding antiviral treatment) could increase by more than 25 million Swiss francs (CHF) between 2013 and 2030. Since that publication, highly efficacious directacting antiviral therapies (DAAs) have become available, making HCV elimination a possibility. This analysis quantifies the clinical and economic burden of HCV intervention strategies over the next 15 years. METHODS: A model was developed to estimate the future clinical and economic burden of HCV infection if patients are diagnosed and treated according to a historical paradigm (historical base case), or at higher levels without treatment reimbursement restrictions (Scenario 1). The infected population was tracked by age- and sex-defined cohorts, and associated direct medical costs (healthcare, screening, diagnostics and treatment) and quality-adjusted life years (QALYs) were calculated. Direct cost savings and the incremental cost-effectiveness ratio (ICER) were calculated to assess the economic impact of each scenario. Additionally, we generated a net-zero cost scenario (Scenario 2), assuming the same treatment paradigm as Scenario 1 but at the treatment price that would break even by 2031. RESULTS: In the historical base case, annual direct costs are projected to decrease from 150 million (95% UI: 132–170 million) CHF in 2016 to 90 million (95% UI: 65–111 million) CHF in 2031. Cumulative direct costs are projected to reach 1.7 billion (95% UI: 1.2–2.0 billion) CHF by 2031. In Scenario 1, annual direct costs first increased to 175 million CHF by 2018, before declining to 44 million CHF by 2031. Cumulative direct costs in this scenario are projected to reach 1.8 billion CHF by 2031. For Scenario 2, the treatment price needed to achieve break-even by 2031 considering only direct costs would be 27,900 CHF per patient. By 2031, Scenarios 1 and 2 would gain 58,300 QALYs. In both scenarios, the ICER drops below the costeffectiveness threshold of 78,000 CHF in 2018. Over the 15-year span, the ICER was determined to be 2,200 CHF for Scenario 1. CONCLUSIONS: Increasing the number of patients treated and treating all fibrosis stages is cost-effective compared to the historical base case and could achieve breakeven by 2031 at a price of 27,900 CHF. Key words: hepatitis C virus, liver cirrhosis, hepatocellular carcinoma, Switzerland, cost-effectiveness, quality-adjusted life years, direct-acting antiviral