Cost analysis of sofosbuvir/ribavirin versus sofosbuvir/simeprevir for genotype 1 hepatitis C virus in interferon-ineligible/intolerant individuals


  • Liesl M. Hagan,

    Corresponding author
    1. Center for AIDS Research, Emory University School of Medicine and Veterans Affairs Medical Center, Atlanta, GA
    • Address reprint requests to: Liesl M. Hagan, cMPH, Emory University School of Medicine, 1760 Haygood Drive NE, Room E420, Atlanta, GA 30322. E-mail:; fax: +1-404-727-1330.

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  • Mark S. Sulkowski,

    1. Johns Hopkins University School of Medicine, Baltimore, MD
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  • Raymond F. Schinazi

    1. Center for AIDS Research, Emory University School of Medicine and Veterans Affairs Medical Center, Atlanta, GA
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  • Potential conflict of interest: Dr. Sulkowski consults and received grants from AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Janssen, Merck, and Gilead.

  • This work was supported, in part, by the National Institutes of Health (grant nos.: P30-AI-050409 [to R.F.S.] and K24-DA-034621 [to M.S.S.]) and the Department of Veterans Affairs (to R.F.S.).

  • See Editorial on Page 12


Treatment guidance for chronic hepatitis C (CHC) released by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) offers two options for interferon (IFN)-ineligible/intolerant individuals with genotype 1 infection: sofosbuvir/ribavirin (SOF/RBV) for 24 weeks or sofosbuvir/simeprevir (SOF/SMV) for 12 weeks. A 24-week course of SOF/RBV costs approximately US$169,000, with sustained virologic response (SVR) rates ranging from 52% to 84%; 12 weeks of SOF/SMV costs approximately $150,000, with SVR between 89% and 100%. Because SOF/SMV is currently used off-label, debate exists among physicians and payers about whether it should be prescribed and covered. This article presents a cost-effectiveness analysis of these two treatment regimens accounting for costs of drugs, treatment-related medical care, retreatment for individuals who do not achieve SVR, and natural history of continued HCV infection after failed retreatment. Analysis uses a Markov model with a lifetime horizon and a societal perspective. In the base-case scenario, SOF/SMV dominated SOF/RBV in a modeled 50-year-old cohort of treatment-naïve and -experienced subjects, excluding those who failed earlier therapy with telaprevir or boceprevir. SOF/SMV yielded lower costs and more quality-adjusted life years (QALYs) for the average subject, compared to SOF/RBV ($165,336 and 14.69 QALYs vs. $243,586 and 14.45 QALYs, respectively). In base-case cost analysis, the SOF/SMV treatment strategy saved $91,590 per SVR, compared to SOF/RBV. Under all one-way sensitivity scenarios, SOF/SMV remained dominant and resulted in cost savings. Conclusions: These results suggest that a 12-week course of SOF/SMV is a more cost-effective treatment for genotype 1 CHC than 24 weeks of SOF/RBV among IFN-ineligible/intolerant individuals, supporting the AASLD/IDSA guidance and offering implications for both clinical and regulatory decision making as well as pharmaceutical pricing. (Hepatology 2014;60:37–45)