Economic evaluation of hepatitis C treatment extension to acute infection and early-stage fibrosis among patients who inject drugs in developing countries: A case of China

Yin Liu, Hui Zhang, Lei Zhang, Xia Zou, Li Ling

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We aimed to assess the cost-effectiveness of (1) treating acute hepatitis C virus (HCV) vs deferring treatment until the chronic phase and (2) treating all chronic patients vs only those with advanced fibrosis; among Chinese genotype 1b treatment-naïve patients who injected drugs (PWID), using a combination Daclatasvir (DCV) plus Asunaprevir (ASV) regimen and a Peg-interferon (PegIFN)-based regimen, respectively. A decision-analytical model including the risk of HCV reinfection simulated lifetime costs and quality-adjusted life-years (QALYs) of three treatment timings, under the DCV+ASV and PegIFN regimen, respectively: Treating acute infection (“Treat at acute”), treating chronic patients of all fibrosis stages (“Treat at F0 (no fibrosis)”), treating only advanced-stage fibrosis patients (“Treat at F3 (numerous septa without cirrhosis)”). Incremental cost-effectiveness ratios (ICERs) were used to compare scenarios. “Treat at acute” compared with “Treat at F0” was cost-saving (cost: DCV+ASV regimen—US$14,486.975 vs US$16,224.250; PegIFN-based regimen—US$19,734.794 vs US$22,101.584) and more effective (QALY: DCV+ASV regimen— 14.573 vs 14.566; PegIFN-based regimen—14.148 vs 14.116). Compared with “Treat at F3”; “Treat at F0” exhibited an ICER of US$3780.20/QALY and US$15,145.98/QALY under the DCV+ASV regimen and PegIFN-based regimen; respectively. Treatment of acute HCV infection was highly cost-effective and cost-saving compared with deferring treatment to the chronic stage; for both DCV+ASV and PegIFN-based regimens. Early treatment for chronic patients with DCV+ASV regimen was highly cost-effective.

Original languageEnglish
Article number800
Number of pages13
JournalInternational Journal of Environmental Research and Public Health
Issue number3
Publication statusPublished - Feb 2020


  • Antiviral treatment
  • Cost-effectiveness
  • Hepatitis C virus
  • People who inject drugs

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