THE SCOPE OF VALUE AND OPPORTUNITY LOSS IN TREATING HEPATITIS C
Purpose: New therapies for Hepatitis C (HCV) are curative, but costly. We estimate the economic value of providing treatment for HCV in the US and compare it to the value of major federally regulated health interventions, such as the Clean Air Act.
Methods: Using a value of statistical life (VSL) and value of statistical life year (VSLY) framework, we calculate the net monetary benefit (NMB) of life-years saved if sofosbuvir-containing therapy is provided for all individuals estimated to have HCV based from the National Health and Examination Survey, 2003-2010. We assumed a VSL of 5 million USD. The VSLY is the quotient of VSL and the discounted expected remaining life-years for the general population at a mean age of 52. The NMB of therapy is the product of VSLY and the remaining life-years associated with treatment, minus the incremental cost. Outcomes are discounted at 3%. We project life expectancy and costs using the HCV Cost-Effectiveness (HCV-CE) Monte Carlo simulation model. In sensitivity analyses, we vary prices for HCV drugs (100% to 55%) to reflect potential offsets of rebates and other discounts, as well as the VSL (1 to 10 million USD). We compare valuations to those of other federally supported interventions.
Results: Treating 2.7 million individuals with HCV will result in 9.5 million life-years saved at an incremental cost of $345 billion dollars compared to no treatment. The VSLY is $274,000 dollars. The NMB of hepatitis C therapy is $2.2 trillion dollars, and ranges from $176 billion to $4.9 trillion dollars at VSL of $1 million to $10 million dollars, respectively. When we discount the price of medications by 45%, the NMB of therapy is $2.4 trillion dollars, with an incremental cost of therapy of $187 billion dollars. The NMB and cost exceed that of other federal regulations impacting health (Figure 1).
Conclusions: The economic value, and absolute cost accrued by treating HCV is on the order of the largest federal health interventions, such as the Clean Air Act. The effects are large due to the high mortality risk of HCV, the curative effect of therapy, therapy cost, and the size of the population. Concurrent efforts to expand access to and reduce the cost of therapy should be a priority at the federal level.