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

• Published in: Journal of clinical and translational hepatology Vol. 5; no. 1; pp. 16 - 22
• Main Authors: Jayasekera, Channa R, Beckerman, Rachel, Smith, Nathaniel, Perumpail, Ryan B, Wong, Robert J, Younossi, Zobair M, Ahmed, Aijaz
• Format: Journal Article
• Language: English
• Published: United States Center for Innovation in Global Health, Stanford University, Stanford, California, USA%Maple Health Group, LLC, New York, New York, USA%Liver Transplant Program, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA%Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, California, USA%Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia, USA 28.03.2017; Liver Transplant Program, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA; XIA & HE Publishing Inc
• Subjects: Original; Task shifting; Treatment access; Cost effectiveness; Hepatitis C
• ISSN: 2225-0719; 2310-8819
• DOI: 10.14218/JCTH.2016.00052

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 Gen DAAs), may increase treatment capacity, and may facilitate greater treatment access. We determined the cost effectiveness of 2 Gen DAAs with respect to interferon-based first-generation DAAs (1 Gen DAAs) within a task-shifted treatment model. 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 Gen DAAs was modeled based on our outreach clinic's data. Adverse events, utility, costing, and transition probabilities were sourced from the literature. Driven by improved effectiveness and safety, as well as an expected increase in treatment capacity, 2 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 Gen DAAs. Trends were consistent across all assessed patient subpopulations. Based on an assumption of increased treatment capacity accompanying a task-shifted treatment model, 2 Gen DAAs-based treatment was cost effective and cost saving as compared to 1 Gen DAAs-based treatment for all HCV patient subgroups assessed.