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Cost-effectiveness of increased screening and treatment of chronic hepatitis C in Korea

Authors
 Do Young Kim  ;  Gabriel Wong  ;  Janet Lee  ;  Myung Hwa Kim  ;  Nathaniel Smith  ;  Rob Blissett  ;  Hyung Joon Kim 
Citation
 CURRENT MEDICAL RESEARCH AND OPINION, Vol.36(6) : 993-1002, 2020-06 
Journal Title
 CURRENT MEDICAL RESEARCH AND OPINION 
ISSN
 0300-7995 
Issue Date
2020-06
Keywords
Hepatitis C ; South Korea ; cost-effectiveness ; cost-utility ; glecaprevir/pibrentasvir ; ledipasvir/sofosbuvir
Abstract
Background: Given a hepatitis C virus (HCV) elimination goal by 2030, World Health Organization (WHO) guidelines recommend scaling up HCV screening and treatment with highly-effective direct-acting antivirals (DAAs). This study investigated the cost-effectiveness of various screening and treatment strategies for chronic HCV patients in South Korea in patients aged over 40 as compared to currently screening only high-risk patients.Methods: A published Markov disease progression model was used with a screening/treatment decision-tree to model different screening and treatment strategies for Korean HCV patients (aged over 40) from a national payer perspective over a lifetime time horizon. The screening strategies included "screen-all" (upfront only: "once"; or upfront and age 65: "twice") or a "high-risk only" screening strategy followed by treatment. Treatment strategies included either ledipasvir/sofosbuvir (LDV/SOF), SOF + ribavirin (SOF + RBV; in GT2 only), or glecaprevir/pibrentasvir (GLE/PIB). Model inputs were sourced from published literature and costing databases and validated by Korean hepatologists.Results: Regardless of treatment strategy, a "screen all twice" scenario led to the lowest rates of advanced liver disease events compared to "screen all once" and "high-risk only" screening scenarios. In this screening scenario, treatment with LDV/SOF for GT1/2 dominates (i.e. is more effective and less4costly) LDV/SOF in GT1 and SOF + RBV in GT2, while GLE/PIB is not cost-effective relative to LDV/SOF (₩105,124,920/QALY) at a willingness-to-pay threshold of 1xGDP per capita.Conclusion: Screening all South Korean patients twice followed by LDV/SOF treatment is cost-effective as compared current high-risk screening. Adopting this strategy can help achieve WHO HCV elimination goals.
Full Text
https://www.tandfonline.com/doi/full/10.1080/03007995.2020.1756232
DOI
10.1080/03007995.2020.1756232
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/179434
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