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Abstract

Hepatitis C is thought to infect 3-5 million Americans, frequently resulting in cirrhosis and related diseases. The treatment up until recently had been based on interferon and ribaviron with efficacy rates of under 40% for most patients, much lower on an intention to treat basis. Several new oral anti-viral treatments have been developed and approved, now with efficacy rates of 90-99%. Treatment costs have been controversial with per pill prices set at $1,000-$1,125. We set out to examine the cost effectiveness of these new treatments.Life expectancy is estimated to improve 15 years in patients cured with early disease; this is reduced in patients with advanced disease. The model incorporates the observation of log-rhythmic increase in mortality as cirrhosis occurs. The HCV Medical Treatment Model predicts a cost of $6,467 per year of life saved for patients treated with no cirrhosis. The same model calculates a cost $160,500 per year of life saved for patients with advanced cirrhosis. The current benchmark of cost per year of hemodialysis is $72,000-89,000. The model suggests patients with early HCV disease are cost effective to treat with the most current medical treatment regimens, but not so for patients with cirrhosis.

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