Cost-Utility and Budget Impact Analysis of Hepatitis C Virus Treatment With Sofosbuvir-based Regimens in Thailand

Hepatitis C caused liver diseases is one of major disease burden in low- and middle-income countries. Many economic evaluation studies worldwide showed the evidence that using medicines for hepatitis C treatment provides enough benefit to patients when justify its cost. However, in 2011, there was no any studies conducted to be considered in the context of Thailand. In the same time, there was no any medicines for hepatitis C treatment included in the pharmaceutical reimbursement list of Thailand as well. As a consequence, the first economic evaluation study on hepatitis C treatment was established resulting in the evidence of using peg-interferon alfa 2a or 2b with ribavirin presents advantage outweigh their high cost for patients genotype 2 and 3. In 2013, the Sub-committee for Development of the National List of Essential Medicines (NLEM) decided to select these medicines into the formulary. After that, the other questions had been raised to the Sub-committee for Development of the NLEM whether equity or not that patients genotype 2 and 3 be the only beneficiaries? and is it appropriate to exclude HIV-HCV co-infection patients to have drugs reimbursed because their qualification are not meet the criteria of the NLEM? According to the incidence of hepatitis C in Thailand, the most 3 common genotypes are genotype 3 (30-40%), genotype 1 (20-30%) and genotype 6 (10-20%), two studies were performed to evaluate the cost-effectiveness of using peg-interferon alfa 2a or 2b with ribavirin among patients who are genotype 1 and 6 and who are HIV-HCV co-infection. At the end, in 2015, the Sub-committee for Development of the NLEM adopted the regimens of peg-interferon alfa 2a or 2b with ribavirin for hepatitis C patients genotype 1, 2, 3 and 6 whether or not they are HIV-HCV co-infection to include in the NLEM of Thailand.

Recently, however, there are the newly developed and highly expensive medicines for the treatment of hepatitis C patients named direct-acting antiviral agents (DAAs), This group of medicines has higher efficacy and fewer side effects when compare with the standard treatment (peg-interferon alfa 2a or 2b with ribavirin). As a result, new economic evaluation study has been developed to compare the regimens among the standard treatment, DAA plus standard treatment, and only dual DAA combination.