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Cost-effectiveness analysis of treatment timing considering the future entry of lower-cost generics for hepatitis C

Authors Heath K

Received 16 April 2018

Accepted for publication 27 May 2018

Published 20 September 2018 Volume 2018:10 Pages 539—550


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Professor Samer Hamidi

Katherine Heath1,2

1Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford OX1 3PS, UK; 2New College, Oxford OX1 3BN, UK

Background: Cost-benefit analyses are crucial to inform treatment policies, particularly when the cost of patented drugs is very high. The cost of patented drugs is the limiting factor in hepatitis C treatment. However, hepatitis C drug costs are expected to fall following patent expiration, due to generic drug introduction.
Methods: An existing mathematical model by Shih et al was extended to consider lower-cost future generics in health economic models of hepatitis C. The model compared the cost-effectiveness of treating patients now with patented drugs vs postponing treatment until after patent expiration.
Results: For ledipasvir-sofosbuvir, this study finds that it is almost always more cost effective to treat hepatitis C with high-cost patented drugs immediately rather than waiting for patent expiry. For ledipasvir-sofosbuvir, a generic would need to enter the market at <16.40% of the patented price for delayed treatment to be cost effective. The further that patent expiry is in the future, the more cost effective delayed treatment becomes; however, uncertainty about generic pricing and market entry times are also higher if patent expiry is in the distant future.
Conclusion: It is more cost effective to treat hepatitis C sooner rather than later, regardless of the stage of the disease, and despite the high cost of patented drugs. However, patented drugs are being produced globally for prices much lower than those seen in the UK. Therefore, negotiation of patented drug prices with pharmaceutical companies may be a crucial step in cost effective treatment of hepatitis C.

Keywords: ledipasvir, sofosbuvir, cost-per-QALY-gained, drug patent expiry, HCV, hepatitis C treatment

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