OBJECTIVES : The arise of direct-acting antivirals (DAAs) has dramatically improved the efficacy and reduced the incidence of adverse events, making it possible to cure hepatitis C. Since 2017, several DAAs have been approved through priority approval procedures in China. Although genotype 1 is the most common in China, non-genotype 1 patients also need our attention. So our aim was to investigate the cost-utility of DAAs for non-genotype 1 patients and to afford some references for decision-making in China.

METHODS : A Markov model was established to estimate the lifetime costs, quality adjusted life years (QALYs) and the incremental cost-utility ratio (ICUR) for DAAs compared with pegylated interferon plus ribavirin (PR) from a societal perspective. The model input came from literatures, key opinion leader interviews, and databases specific to China. Sensitivity analyses were performed to evaluate model robustness and threshold analyses were performed to detect reasonable price for DAAs.

RESULTS : For genotype 2, the pan-genotypic regimen sofosbuvir/velpatasvir was the most cost-effective compared with PR. As for genotype 3, the combination of sofosbuvir and daclatasvir was the most cost-effective. All DAA regimens for genotype 6 was cost-saving with sofosbuvir plus ribavirin being the optimal strategy. The incidence of long-term complications decreased significantly for all patients using DAAs. Probabilistic sensitivity analyses showed that the corresponding optimal strategy for each genotype had a probability of 58%, 83%, and 71% of being cost-effective compared with PR, respectively. Threshold analyses showed that the price of DAAs should be reduced by a certain degree to achieve better performance.

CONCLUSIONS : For non-genotype 1 hepatitis C patients in China, DAAs are more cost-effective than PR, and they produce better health outcomes and higher quality of life. More importantly, reasonable price reduction of DAAs will increase drug affordability and is of great significance for the global strategy to eliminate viral hepatitis.