Sofosbuvir-based Regimens with Task Shifting Is Cost-effective in Expanding Hepatitis C Treatment Access in the United States

Channa R Jayasekera; Rachel Beckerman; Nathaniel Smith; Ryan B Perumpail; Robert J Wong; Zobair M Younossi; Aijaz Ahmed

doi:10.14218/JCTH.2016.00052

Sofosbuvir-based Regimens with Task Shifting Is Cost-effective in Expanding Hepatitis C Treatment Access in the United States

J Clin Transl Hepatol. 2017 Mar 28;5(1):16-22. doi: 10.14218/JCTH.2016.00052. Epub 2017 Feb 2.

Authors

Channa R Jayasekera^{1

2}, Rachel Beckerman³, Nathaniel Smith³, Ryan B Perumpail¹, Robert J Wong⁴, Zobair M Younossi^{5

6}, Aijaz Ahmed¹

Affiliations

¹ Liver Transplant Program, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA.
² Center for Innovation in Global Health, Stanford University, Stanford, California, USA.
³ Maple Health Group, LLC, New York, New York, USA.
⁴ Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, California, USA.
⁵ Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia, USA.
⁶ Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.

Abstract

Background and Aims: The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection (HCV) is inefficient in absorbing the approximately 3 million patients awaiting treatment in the United States. Task shifting-whereby specialist physicians screen patients for treatment eligibility but on-treatment monitoring is devolved to more abundant non-physician clinicians-achieves non-inferior treatment outcomes with second generation direct-acting antivirals (2^nd Gen DAAs), may increase treatment capacity, and may facilitate greater treatment access. We determined the cost effectiveness of 2^nd Gen DAAs with respect to interferon-based first-generation DAAs (1^st Gen DAAs) within a task-shifted treatment model. Methods: Using a previously described decision-analytic Markov structure, we modeled a hypothetical cohort of 1,000 patients with HCV genotype 1 infection over a lifetime horizon, based upon our outreach clinic's HCV treatment protocol. Treatment-naïve and treatment-experienced HCV cohorts were modeled separately, based upon our outr8each clinic's demographics. Treatment response to 2^nd Gen DAAs was modeled based on our outreach clinic's data. Adverse events, utility, costing, and transition probabilities were sourced from the literature. Results: Driven by improved effectiveness and safety, as well as an expected increase in treatment capacity, 2^nd Gen DAAs treatment monitored by non-physician clinicians was projected to improve health outcomes and be dominant from a cost-effective perspective versus that of 1^st Gen DAAs. Trends were consistent across all assessed patient subpopulations. Conclusions: Based on an assumption of increased treatment capacity accompanying a task-shifted treatment model, 2^nd Gen DAAs-based treatment was cost effective and cost saving as compared to 1^st Gen DAAs-based treatment for all HCV patient subgroups assessed.

Keywords: Cost effectiveness; Hepatitis C; Task shifting; Treatment access.