Date Published: February 21, 2018
Publisher: Public Library of Science
Author(s): Waranya Rattanavipapong, Thunyarat Anothaisintawee, Yot Teerawattananon, Jee-Fu Huang.
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.
Around 150 million people worldwide have hepatitis C viral (HCV) infection with most cases in East and Central Asia . Thailand, a high-middle income country in South East Asia, is one of the countries with the highest number of HCV patients, with approximately 759, 000 cases . The prevalence of HCV infection is 2.8% which is increased to 8.4% in patients with Human Immunodeficiency Virus (HIV) infection in adults aged 21–60 years. In addition, Thailand is also found to have a unique HCV genotype 3 prevalence, although HCV genotype 1 is most common globally .
This study demonstrates that the Thai government needs to change its current treatment policy for chronic HCV infection since all three new treatment policies using sofosbuvir-based regimens are likely to yield more health benefit with lower cost compared to the current policy.