부산대학교 도서관

Aims: Japanese chronic hepatitis C (CHC) patients are at greater risk for hepatocellular carcinoma (HCC). Highly effective oral Direct Acting Antiviral (DAA) regimens for CHC can lead to high SVR rates that reduce CHC complications and costs. This study estimated the economic benefit of CHC cure by reducing HCC and decompensated cirrhosis (DCC) in Japan. Methods: A hypothetical cohort of 10,000 HCV GT1b Japanese patients with a mean age of 70 was modeled with a hybrid decision tree and Markov model capturing the natural history of HCV infection over a lifetime horizon. It was assumed that 15% of the cohort had cirrhosis and 20% were treatment-experienced. Treatment compared approved all-oral DAAs vs. no treatment (NT) with efficacy based on randomized controlled trials. Transition rates and costs were obtained from Japan-specific data. DCC, HCC and quality-adjusted life years (QALYs) were projected. QALYs were monetized using a willingness to pay (WTP) threshold which varied from ¥4 to ¥6 million. The incremental savings associated with treatment were calculated by adding the projected cost of complications avoided to the monetized gains in QALYs. Results: DAA treatment avoided 1583 cases of HCC and 1162 cases of DCC, saving ¥618,076 and ¥251,329 per treated patient; respectively. Treatment leads to avoidance of 2745 cases of CHC complications and associated savings of ¥869,405 per treated patient. Additionally, DAA treatment lead to an additional 1.59 QALYs gained per patient treated. The indirect economic gains associated with treatment-related QALY improvements were estimated to be ¥6,360,000, ¥7,950,000 and ¥9,540,000 per patient at WTP thresholds of ¥4 million, ¥5 million and ¥6 million. Total economic savings of HCV GT1 treatment with DAAs (vs. NT) was ¥7,229,405, ¥8,819,405and ¥10,409,405 at these different WTP thresholds. Conclusions: Treatment of HCV GT1b with all Oral DAAs in Japan can lead to significant savings related to avoidance of HCC and DCC.