Objective: To assess the long-term
healthcare costs and
health outcomes in
association with the access to new direct-acting
antivirals (DAAs), during the first year of the National Strategic Plan for
Chronic Hepatitis C (SPCHC) in
patients with
chronic hepatitis C (CHC) in
Spain .
Methods: A
decision tree and a lifetime Markov model were developed to simulate the
natural history ,
morbidity , and
mortality of a cohort of 51,900
patients with CHC before (pre-DAA strategy) and after (post-DAA strategy) access to DAAs, following SPCHC approval. The percentage of
patients treated, transition
probabilities ,
disease management costs, health state utility values,
sustained virologic response rates and
treatment costs were obtained from the
literature and published data from
Spain . The results were expressed in terms of
costs (Euros, 2016),
quality-adjusted life years (
QALYs ) and prevention of clinical events, with an annual discount rate of 3%.
Results: The post-DAA strategy would prevent 8,667 cases of decompensated
cirrhosis , 5,471 cases of
hepatocellular carcinoma , 1,137
liver transplants and 9,608
liver -related deaths. The cohort of 51,900
patients would require
investments of 1,606 and 1,230 million euros with the post-DAA and pre-DAA
strategies , respectively. This would produce 819,674 and 665,703
QALYs .
Conclusions: The use of new DAA-based
treatments in CHC
patients during the first year after the implementation of the SPCHC significantly reduced long-term
morbidity and
mortality and increased
quality of life ; demonstrating that this plan is an efficient use of
public health resources (AU)