Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C?
Abstract Introduction The treatment of hepatitis C has entered the pan-genotypic era, but the effectiveness is not good for the genotype 3b patients who have a large proportion in China. The guidelines for hepatitis C recommend the use of gene-specific regimens when the regional 3b prevalence rate g...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Cost Effectiveness and Resource Allocation |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12962-024-00519-2 |
| _version_ | 1797274479754215424 |
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| author | Yusi Tu Xiangyan Tang Dachuang Zhou Hanqiao Shao Leyi Liang Wenxi Tang |
| author_facet | Yusi Tu Xiangyan Tang Dachuang Zhou Hanqiao Shao Leyi Liang Wenxi Tang |
| author_sort | Yusi Tu |
| collection | DOAJ |
| description | Abstract Introduction The treatment of hepatitis C has entered the pan-genotypic era, but the effectiveness is not good for the genotype 3b patients who have a large proportion in China. The guidelines for hepatitis C recommend the use of gene-specific regimens when the regional 3b prevalence rate greater than 5%. This study is to explore rationality of this proportion and the cost-effectiveness to implement pan-genotypic regimens in China. Methods A decision Markov model was developed from the health system perspective to evaluate the effectiveness and cost-effectiveness between pan-genotypic and gene-specific treatment regimens for hepatitis C patients. Additionally, we set a regional genotype 3b patient proportion of 0–100% to explore at which proportion it is necessary to perform genotype identification and typing therapy on patients. Model parameters were derived from published literature and public databases. Effectiveness was measured by cured patient numbers, newly diagnosed cases of decompensated cirrhosis, hepatocellular carcinoma, need for liver transplantation, and quality-adjusted life years (QALYs). Cost-effectiveness outcomes included costs and the incremental cost-effectiveness ratio (ICER). The 1–3 times 2022 Chinese per capita gross domestic product was used as the willingness-to-pay threshold. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. Results Compared with gene-specific regimens, pan-genotypic regimens resulted in an additional 0.13 QALYs and an incremental cost of $165, the ICER was $1,268/QALY. From the view of efficacy, the pan-genotypic regimens cured 5,868 more people per 100,000 patients than gene-specific regimens, avoiding 86.5% of DC cases, 64.6% of HCC cases, and 78.2% of liver transplant needs. Identifying 3b patients before treatment was definitely cost-effectiveness when their prevalence was 12% or higher. The results remained robust in sensitivity analyses. Conclusions In China, the prioritized recommendation of pan-genotypic therapeutics proves to be both cost-effective and efficacious. But, in regions where the prevalence of genotype 3b exceeds 12%, it is necessary to identify them to provision of more suitable therapies. |
| first_indexed | 2024-03-07T14:58:58Z |
| format | Article |
| id | doaj.art-ec187ac0bdbc42d69eba541190c64c2a |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-03-07T14:58:58Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-ec187ac0bdbc42d69eba541190c64c2a2024-03-05T19:15:53ZengBMCCost Effectiveness and Resource Allocation1478-75472024-02-0122111010.1186/s12962-024-00519-2Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C?Yusi Tu0Xiangyan Tang1Dachuang Zhou2Hanqiao Shao3Leyi Liang4Wenxi Tang5Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical UniversityCenter for Pharmacoeconomics and Outcomes Research, China Pharmaceutical UniversityCenter for Pharmacoeconomics and Outcomes Research, China Pharmaceutical UniversityCenter for Pharmacoeconomics and Outcomes Research, China Pharmaceutical UniversityCenter for Pharmacoeconomics and Outcomes Research, China Pharmaceutical UniversityCenter for Pharmacoeconomics and Outcomes Research, China Pharmaceutical UniversityAbstract Introduction The treatment of hepatitis C has entered the pan-genotypic era, but the effectiveness is not good for the genotype 3b patients who have a large proportion in China. The guidelines for hepatitis C recommend the use of gene-specific regimens when the regional 3b prevalence rate greater than 5%. This study is to explore rationality of this proportion and the cost-effectiveness to implement pan-genotypic regimens in China. Methods A decision Markov model was developed from the health system perspective to evaluate the effectiveness and cost-effectiveness between pan-genotypic and gene-specific treatment regimens for hepatitis C patients. Additionally, we set a regional genotype 3b patient proportion of 0–100% to explore at which proportion it is necessary to perform genotype identification and typing therapy on patients. Model parameters were derived from published literature and public databases. Effectiveness was measured by cured patient numbers, newly diagnosed cases of decompensated cirrhosis, hepatocellular carcinoma, need for liver transplantation, and quality-adjusted life years (QALYs). Cost-effectiveness outcomes included costs and the incremental cost-effectiveness ratio (ICER). The 1–3 times 2022 Chinese per capita gross domestic product was used as the willingness-to-pay threshold. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. Results Compared with gene-specific regimens, pan-genotypic regimens resulted in an additional 0.13 QALYs and an incremental cost of $165, the ICER was $1,268/QALY. From the view of efficacy, the pan-genotypic regimens cured 5,868 more people per 100,000 patients than gene-specific regimens, avoiding 86.5% of DC cases, 64.6% of HCC cases, and 78.2% of liver transplant needs. Identifying 3b patients before treatment was definitely cost-effectiveness when their prevalence was 12% or higher. The results remained robust in sensitivity analyses. Conclusions In China, the prioritized recommendation of pan-genotypic therapeutics proves to be both cost-effective and efficacious. But, in regions where the prevalence of genotype 3b exceeds 12%, it is necessary to identify them to provision of more suitable therapies.https://doi.org/10.1186/s12962-024-00519-2Hepatitis CPan-genotypic regimensCost-effectiveness analysisDecision-analytic Markov model |
| spellingShingle | Yusi Tu Xiangyan Tang Dachuang Zhou Hanqiao Shao Leyi Liang Wenxi Tang Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C? Cost Effectiveness and Resource Allocation Hepatitis C Pan-genotypic regimens Cost-effectiveness analysis Decision-analytic Markov model |
| title | Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C? |
| title_full | Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C? |
| title_fullStr | Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C? |
| title_full_unstemmed | Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C? |
| title_short | Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C? |
| title_sort | is it time for china to prioritize pan genotypic regimens for treating patients with hepatitis c |
| topic | Hepatitis C Pan-genotypic regimens Cost-effectiveness analysis Decision-analytic Markov model |
| url | https://doi.org/10.1186/s12962-024-00519-2 |
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