Real-World Value of Direct-Acting Antivirals for Hepatitis C at Kaiser Permanente Southern California

Am J Manag Care. 2023;29(10):e299-e306. https://doi.org/10.37765/ajmc.2023.89444 _____ Takeaway Points Use of direct-acting antivirals (DAAs) in patients with hepatitis C virus (HCV) in the Kaiser Permanente Southern California health care system can provide value by reducing long-term HCV-related morbidity and mortality while quickly providing a net monetary benefit. * Over a lifetime horizon, DAAs are predicted to result in a significant reduction in advanced liver disease events compared with no treatment. * DAA intervention dominated (ie, was more effective and less costly than) no treatment. * DAAs are anticipated to result in a total cost savings of $1 billion over a lifetime horizon compared with no treatment based on a hybrid decision-tree Markov state-transition model. Cost savings are anticipated to be achieved quickly post treatment, with DAAs being less costly than the untreated scenario after 3 years. _____ Hepatitis C virus (HCV) infection is the most common blood-borne infectious disease in the United States, with more than 2 million Americans currently infected.1 Although nonalcoholic fatty liver disease is a rapidly growing cause of chronic liver disease resulting in an increase in advanced liver disease,2,3 HCV remains a leading cause of liver-related morbidity and mortality in the United States and may cause numerous extrahepatic manifestations.4,5 Persons born between 1945 and 1965 have been identified as the population cohort with the highest prevalence of HCV.1,6,7 Consequently, the prevalence of advanced liver disease is expected to increase in the coming years, which is anticipated to lead to an increase in costly liver-related events.4 HCV treatment has evolved with the introduction of interferon (IFN)–free direct-acting antivirals (DAAs),8 which have higher efficacy (ie, sustained virologic response [SVR] rates) and good safety profiles and thus can be used in patients with IFN contraindications and IFN intolerance.9 Further, achievement of SVR, defined as cure from HCV, prevents the risk of liver disease progression and is associated with a decrease in advanced liver disease events,10 increased life expectancy, and a substantial reduction in overall mortality.10,11 DAAs result in initial cure rates of more than 95%12,13; however, the high cost of DAAs leads to a high budget impact in the short term. Price et al examined the experience of all Kaiser Permanente Northern California patients initiating telaprevir or boceprevir triple