| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 107 === Background
The direct-acting antivirals (DAAs) have recently shown better treatment outcomes than conventional peginterferon plus ribavirin for the treatment of hepatitis C virus. Taiwan Ministry of Health and Welfare decided to extend coverage for pan-genotypic DAAs to all the patients with hepatitis C, not just severe liver fibrosis or specific genotype in 2019. However, the real impact of extending insurance coverage unconditionally is still unknown.
Objective
This study aimed to assess the budget impact of introducing the pan-genotypic DAAs therapies to all stages and genotypes from the perspective of the Taiwan health care payer.
Methods
A budget impact model was developed with a five-year time horizon (2019-2023) to estimate the
drug-related costs and budget impact on the National Health Insurance. Based on the real-world cost data and modeling assumptions, we compared the two scenarios: the current payment condition, in which patients with F3 or above fibrosis received preferential treatment with DAAs, other patients that do not meet the usage criteria still received interferon-based treatments; the new scenario, with the pan-genotypic DAAs as a first-line treatment for all degrees of fibrosis or cirrhosis. Total annual costs were estimated for patients eligible to have treatment in the target population, and the maximum coverage of 4,0000 patients per year in both scenarios was assumed. A sensitivity analysis was performed with assumptions that differ from those used in the primary analysis.
Results
Compared to the old scenario, extending pan-genotypic DAAs therapies to all stages and genotypes patients showed a budget impact for the reduction of TWD 1,243million, TWD1,296 million, TWD1,302million, TWD1,320million, TWD1,334 million in the current year, respectively.
In the sensitivity analysis, the prevalence of anti-HCV positive is the most sensitive variables from epidemiology data. The budget impact varied from -TWD 1,287 to -1,204 million when the prevalence of anti-HCV positive varied from 2.1% to 4.4%. Among the cost of treatments, the most sensitive parameter is the average genotype-specific DAAs cost, ranging between -TWD2885 to 338 million.
Conclusions
The results demonstrate that extending coverage to all the patients with direct-acting antivirals is less costly than prioritizing patients with F3 or above fibrosis. The sensitivity analysis shows that the prevalence of anti-HCV positive and the genotype-specific DAAs cost are the sensitive input variables in models.
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