Economic evaluation of Zepatier for the management of HCV in the Italian scenario

BackgroundHepatitis C virus (HCV) is a major health issue worldwide. New generation of direct-active antiviral medications is an epoch-making turning point in the management of HCV infections.ObjectiveConducing a cost-effectiveness analysis comparing the combination of elbasvir/grazoprevir and sofosbuvir+pegylated interferon/ribavirin for the management of all HCV patients (even those in the initial stages of fibrosis).MethodsA Markov model was built on the natural history of the disease to assess the efficacy of the alternatives. The outcomes are expressed in terms of quality adjusted life-years (QALYs) and result in terms of incremental cost-effectiveness ratio).ResultsElbasvir/grazoprevir implies an expenditure of Euro21,104,253.74 with a gain of 19,287.90 QALYs and sofosbuvir+pegylated interferon/ribavirin implies an expenditure of Euro31,904,410.11 with a gain of 18,855.96 QALYs. Elbasvir/grazoprevir is thus a dominant strategy.ConclusionConsideration should be given to the opportunity cost of not treating patients with a lower degree of fibrosis (F0-F2).