OBJECTIVES: CHC has imposed a great burden in China with ~10 million people infected in 2006. Sofosbuvir/Velpatasvir (SOF/VEL) and Ledipasvir/Sofosbuvir (LDV/SOF) (SOF-based directing-acting antivirals [DAAs]) were included in Chinese National Reimbursement Drug List in 2019 for treating non-Genotype (GT) 1b and GT1b patients, respectively. Meanwhile, Elbasvir/Grazoprevir (ERB/GRZ) was listed for treating GT1b patients only. This study aimed to evaluate the economic value of these SOF-based DAAs from China payer’s perspective.

METHODS: Hypothetical cohorts of 10,000 patients were simulated, with a lifetime horizon, using a Markov model. Patient demographics and other inputs were derived from clinical trials, market research, and publications. Lifetime costs accounted for drug costs, monitoring costs, and health-state costs (2020 CNY). Effectiveness in the model included the number of advanced liver disease (ALD) events, sustained virological response (SVR) rate, projected life-years, and QALYs. The cost-effectiveness of SOF-based regimens was compared with conventional treatment (Peginterferon/Ribavirin [PR]) in all patients, and with ERB/GRZ in GT1b subgroup. Costs/effectiveness were discounted at 3%.

RESULTS: Overall, vs PR, SOF-based regimens led to a significant reduction in ALD events (81–93% reduction). SOF-based regimens were dominant vs PR, with lower lifetime costs and higher QALYs (– ¥106,598, +1.24 QALYs). Subgroup analyses showed that: (1) in non-GT1b patients, SOF/VEL dominated PR; (2) in GT1b patients, LDV/SOF dominated PR; LDV/SOF had similar effectiveness but lower lifetime costs and lower cost per SVR vs ERB/GRZ, especially in patients with earlier fibrosis stages.

CONCLUSIONS: SOF-based regimens offer better economic benefits vs PR in China, and provide simpler treatment and broader eligibility vs other DAAs due to being protease inhibitor-free. From a payer’s perspective, SOF-based regimens are more suitable option for CHC treatment in China, with high potential to reduce disease burden and achieve HCV elimination.