Cost Effectiveness Analysis of Adding Sofosbuvir to Pegylated Interferon plus Ribavirin in Treatment of Chronic Hepatitis C Patients

Abstract

The World Health Organization (WHO) data stated that about 71 million people have chronic hepatitis C (CHC), and approximately 400,000 deaths occur annually from CHC complications worldwide. The highest prevalence of HCV infection is present in Egypt, with 92.5% of patients infected with genotype 4. In 2015, the economic burden of HCV in Egypt was estimated to be $3.81 billion, whereas direct health care costs of HCV-associated diseases exceeded $700 million annually. It is expected that the economic burden will exponentially increase as HCV-infected individuals progress to more advanced disease stages of decompensated cirrhosis, HCC, and liver-related mortality. The cumulative total economic burden of HCV disease was estimated at $89.1 billion between 2013 and 2030. The mass HCV treatment program started administering pegylated interferon and ribavirin between 2007 and 2014. The implemented combination of PEGylated interferon and ribavirin regimen (pegIFN/ RBV) in the standard of care for chronic HCV-infected Egyptian patients of genotype 4 was associated with a limited sustained virologic response (SVR), reaching a maximum of 60% and this urged the need for new therapies and the introduction of direct acting antiviral drugs (DAAs). In October 2014, the introduction of sofosbuvir markedly changed therapeutic outcomes. Sofosbuvir is of special interest among the directly acting antiviral drugs under development, due to its high potency, low side effects, oral administration, and high barrier to resistance. In recent years, pharmacoeconomic evaluation has been introduced to healthcare technology assessment organizations expanding the spectrum of economic evaluations and outcomes research aiming to obtain optimum value for patients and healthcare organizations with a special interest in cost effectiveness analysis (CEA). CEA is a full pharmacoeconomic evaluation that compares outcomes and costs of different treatment strategies to determine the best value to return for the strategy’s expenditure.