Economic evaluation of direct‐acting antivirals for the treatment of genotype 3 hepatitis C infection in Singapore

Background and Aim The prohibitively high cost of direct‐acting antivirals (DAA) for hepatitis C virus (HCV) infection remains a barrier to treatment access in Singapore. We aimed to evaluate whether DAA as first‐line therapy would be cost‐effective for genotype 3 (GT3) HCV patients compared with pegylated interferon and ribavirin (PR). Methods A decision tree analysis was used to compare the costs and outcomes of DAA and PR as first‐line therapy. Treatment effectiveness, defined as sustained virological response, was assessed using a retrospective cohort of treated GT3 HCV patients. Direct medical costs were estimated from the payer’s perspective using billing information. We obtained health utilities from published literature. We performed extensive one‐way sensitivity analyses and probabilistic sensitivity analyses to account for uncertainties regarding the model parameters. Results In base case analysis, first‐line therapy with DAA and PR yielded quality‐adjusted life years (QALYs) of 0.69 and 0.62 at a cost of USD 54 634 and USD 23 857, respectively. The resultant incremental cost‐effectiveness ratio (ICER) (USD 449 232/QALY) exceeded the willingness‐to‐pay threshold (USD 53 302/QALY). The ICER was robust for uncertainties regarding the model parameters. The cost of DAA is the key factor influencing the cost‐effectiveness of HCV treatment. At current price, DAA as first‐line therapy is not cost‐effective compared with PR, with or without consideration of retreatment. Threshold analysis suggested that DAA can be cost‐effective if it costs less than USD 17 002 for a 12‐week treatment course. Conclusion At current price, DAA as first‐line therapy is not cost‐effective compared with PR in GT3 HCV patients in Singapore. The introduction of highly efficacious direct acting antiviral agents (DAA) made the elimination of the hepatitis C virus (HCV) an aspirational reality. Currently, due to the prohibitively high cost of DAA, which remains a barrier to treatment access in Singapore, pegylated interferon and ribavirin remain the first‐line treatment for genotype‐3 (GT3) HCV patients in view of its high sustained virological response rate and cost. We sought to determine if DAA would be cost‐effective as first‐line treatment for GT3 HCV patients in Singapore. This finding could be relevant in developing countries, especially in Southeast Asia where GT3 is the predominant genotype.