HCV novel therapeutic regimens in Wonderland: A budget impact analysis in the Lombardy Region

HCV elimination plan leads to significant benefits in managing liver-related diseases and hospital interventions: a regional simulation

OBJECTIVES

This article presents a 3-year budget impact simulation on the effects of a chronic Hepatitis C (HCV) eradication plan in real-life costs incurred by the Regional Health Service.

METHODS

The Liguria Region network performed a prospective 3-year (2017-2019) timeframe horizon trends simulation analysis focusing on management interventions and costs. It involved all the eight prescribing centers in the region, starting from retrospective historical performance data and assuming the impact of sustained viral response rates for patients treated for HCV. Data on hospital admissions, medical visits, number of patients, and deaths were collected through the healthcare database.

RESULTS

At the beginning of 2017, 2,940 patients were eligible for HCV treatment with direct-acting antivirals. Assuming to treat this entire population with a success rate of 90%, the events related to liver complications in the horizon would decrease to 5,538 cumulatively (-35%), with a 27% reduction of direct costs, showing a global savings of 24,779.024 Euros.

CONCLUSION

Treating the entire eligible HCV population would lead to significant benefits and savings in managing liver-related diseases and their direct costs, opening opportunities to re-think new settings for the future organization of liver disease management in the regional health system.

Cost per care of the first year of direct antiviral agents in the Liguria Region: a multicenter analysis

Aims

Despite the remarkable efficacy shown in clinical practice, concerns have been raised about the costs associated with direct antiviral agent (DAA) therapy. This article presents the real-life costs for DAA treatment sustained by the Italian National Health Service in the Liguria Region (Northern Italy).

Methods

A retrospective analysis of the cost per care sustained for DAA treatment, relating to the period from January 1 to December 31, 2015 in five centers in Liguria was performed. All patients undergoing DAA-based treatments for hepatitis C virus (HCV) infection were enrolled. On-treatment costs included: HCV treatment, laboratory test, outpatient services, attended visits, drugs used for the management of adverse events (erythropoietin, albumin or red blood cell packs) and inpatient service admissions.

Results

In total, 327 patients were enrolled. No difference in terms of sustained virologic response (SVR) rate among different treatments was reported. The majority (85.0%) of patients did not report any side effects and only 15 (4.6%) required hospital admission. Forty-two patients (12.8%) required high-cost drugs for the management of adverse events. The overall cost sustained was €14,744,433. DAA±ribavirin (RBV) accounted for the wide majority of this cost (98.9%; €14,585,123). Genotype (GT) 1, the most commonly treated GT, was associated with an average cost of €43,445 per patient. Detailed analysis of the costs for GT 1 showed the treatment based on ritonavir boosted paritaprevir/ombitasvir + dasabuvir±RBV with an average cost of €24,978 (RBV+) and €25,448 (RBV−) per patient was the most cost-effective. The average cost per SVR was €48,184. Once again, the ritonavir boosted paritaprevir/ombitasvir + dasabuvir regimen was associated with the lowest cost/SVR (€25,448/SVR [GT 1b] and similar results for other GTs).

Conclusion

Antiviral regimen is the major contributor to costs in the treatment of HCV infection. Appropriate regimen selection could result in a major cost saving, which can be reinvested to allow more patients to be treated.

Small-molecule inhibitors of hepatitis C virus (HCV) non-structural protein 5A (NS5A): a patent review (2010-2015)

INTRODUCTION

Non-structural 5A (NS5A) protein has achieved a considerable attention as an attractive target for the treatment of hepatitis C (HCV). A number of novel NS5A inhibitors have been reported to date. Several drugs having favorable ADME properties and mild side effects were launched into the pharmaceutical market. For instance, daclatasvir was launched in 2014, elbasvir is currently undergoing registration, ledipasvir was launched in 2014 as a fixed-dose combination with sofosbuvir (NS5B inhibitor). Areas covered: Thomson integrity database and SciFinder database were used as a valuable source to collect the patents on small-molecule NS5A inhibitors. All the structures were ranked by the date of priority. Patent holder and antiviral activity for each scaffold claimed were summarized and presented in a convenient manner. A particular focus was placed on the best-in-class bis-pyrrolidine-containing NS5A inhibitors. Expert opinion: Several first generation NS5A inhibitors have recently progressed into advanced clinical trials and showed superior efficacy in reducing viral load in infected subjects. Therapy schemes of using these agents in combination with other established antiviral drugs with complementary mechanisms of action can address the emergence of resistance and poor therapeutic outcome frequently attributed to antiviral drugs.