New therapies for hepatitis C virus (HCV) are cost-effective for some patients, but current costs may be higher than U.S. insurers are willing to pay, according to a study published in Annals of Internal Medicine.
Recently approved sofosbuvir administered in combination with ribavirin can be used to treat patients with chronic HCV genotype 2 or 3 without interferon, yielding cure rates greater than with the previous standard of care without the fear of toxicity. However, sofosbuvir costs approximately $28,000 for 4 weeks of treatment, which may be too expensive for patients on publicly funded health insurance programs which do not guarantee access to such costly drugs. Using a simulation study, researchers sought to estimate the cost-effectiveness of sofosbuvir-based treatments for HCV genotype 2 or 3 infection in the United States. They found that at current cost, sofosbuvir-based HCV therapy improves outcomes and provides good economic value in patients with cirrhosis and genotype 2 or 3 infection and in those who were previously treated with interferon.
However, in treatment-naive noncirrhotic patients, the incremental cost-effectiveness ratio would be well over $100,000 per quality-adjusted life-year, a cost that may exceed U.S. insurer's commonly cited willingness-to-pay threshold. The authors of an accompanying editorial from the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health suggest that cost may be the only thing standing in the way of eradicating HCV.