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Direct-acting antiviral combination improves work productivity in chronic hepatitis C patients


Treatment with a combination of ledipasvir and sofosbuvir can lead to large economic gains.

A combination of the direct-acting antiviral agents (DAA) ledipasvir and sofosbuvir has a positive impact on work productivity for patients with genotype 1 chronic hepatitis C virus (HCV), according to a new study.

A once-daily, single-tablet dose of ledipasvir/sofosbuvir has been extensively studied in clinical trials and real-world studies. In the ION 1-3 clinical trials, this DAA regimen demonstrated improved patient reported outcome (PRO) scores, including work productivity, during treatment that continued to improve after patients achieved sustained virologic response (SVR). Other studies show improvements in PROs would be expected to generate substantial financial savings in the United States and the European Union, as compared to no treatment.

“Achieving SVR is also associated with benefits outside the liver, including improvement in extrahepatic manifestations, improvements in PROs, and improved work productivity,” said lead author Zobair M. Younossi, MD, of the Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, Falls Church, Va..

The researchers published their results in March 2018 Journal of Viral Hepatitis.

To estimate the potential productivity gains associated with treating genotype 1 HCV patients in four Asian countries with ledipasvir/sofosbuvir, Younossi and colleagues developed an economic model with estimated savings expected for 1 year post-treatment. HCV patients entered the model at 12 weeks post‐treatment, having achieved or not achieved SVR.

Absenteeism (days absent from work) and presenteeism (reduced productivity while at work) rates were taken from a pooled analysis of data from the ION 1‐3 studies. These rates were converted into hours of lost productivity, multiplied by the average wage and applied to the total employed, adult genotype 1 population in Hong Kong, Singapore, South Korea, and Taiwan. Results were compared assuming no treatment, and assuming all patients were treated with the DAA combination.

The results show total productivity losses due to untreated HCV were $11.3 million in Hong Kong, $17.1 million in Singapore, $146 million in South Korea, and $349.1 million in Taiwan. Ledipasvir/sofosbuvir treatment resulted in economic gains of $4.5 million, $6.8 million, $58.7 million, and $138 million, respectively.

“These gains were due to reduced presenteeism. The results were sensitive to changes in the prevalence of HCV and the average wage,” said Younossi. “We found that millions of dollars are lost annually due to decreased work productivity in patients with chronic HCV infection.”
Indirect costs, including components of work productivity (absenteeism and presenteeism), contribute to the total economic burden of HCV and have been shown to outweigh the direct medical costs of the disease, he said.

“Our findings suggest that treatment with interferon and ribavirin-free regimens such as ledipasvir/sofosbuvir can significantly reduce costs resulting from impaired work productivity by reducing presenteeism,” said Younossi. Higher prevalence of HCV and, assuming HCV patients earned an average wage as opposed to the median wage, substantially increased the estimated cost of lost work productivity.

Savings were highest for cirrhotic patients. “This is not surprising, as studies have shown higher physical impairment levels for cirrhotic vs non-cirrhotic patients and that impairments in quality of life can be substantially improved after achieving SVR12,” he said.

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