Back HCV Policy & Advocacy DDW 2015: Hepatitis C Treatment Could Yield Large Economic Benefit

DDW 2015: Hepatitis C Treatment Could Yield Large Economic Benefit

alt

Interferon-free direct-acting antiviral therapy that cures most people with chronic hepatitis C could lead to major economic benefits by reducing lost worker productivity, according to an analysis presented at Digestive Disease Week 2015, now underway in Washington, DC.

Even early hepatitis C can cause symptoms such as fatigue, while long-term infection can lead to cirrhosis, liver cancer, and other complications. The old standard of care -- interferon plus ribavirin -- was so poorly tolerated that many people had to take time off work during treatment lasting 6 to 12 months. In contrast, the newest interferon-free regimens are very well-tolerated and can cure most people in 3 months.

Health economist Zobair Younossi from Inova Fairfax Medical Campus and colleagues used an economic model to estimate worker productivity gains associated with curing genotype 1 chronic hepatitis C using sofosbuvir/ledipasvir (Harvoni) in the U.S., France, Germany, Italy, Spain, and the UK over a time horizon of 1 year.

The model incorporated estimates of the total number of people with hepatitis C in the workforce using country-specific HCV prevalence data. Data about work absenteeism and "presenteeism" were based on Work Productivity and Activity Index-Specific Health Problem (WPAI-SHP) scores from participants enrolled in sofosbuvir/ledipasvir clinical trials. The researchers calculated the value of work hours lost using country-specific data on number of work days per year, hourly wages, and other labor costs.

The analysis showed that treating chronic hepatitis C with sofosbuvir/ledipasvir could lead to an annual societal productivity gain of approximately $2.67 billion per year for the U.S. and $556 million for the 5 European countries. The model predicted an average annual productivity loss of $4954 per employed patient in U.S. and $1129 in the European countries.

"Well-tolerated regimens with high cure rates ([sofosbuvir/ledipasvir]) improve WP scores and could make a substantial positive economic contribution," the researchers concluded. "This indirect economic gain must be considered when assessing the full benefits of treating chronic hepatitis C."

One caution with this type of analysis is that many people with chronic hepatitis C do not have regular employment. Some receive welfare or disability benefits due to other conditions, some are in prison, and a growing number are retiring, given that U.S. HCV prevalence is highest among "Baby Boomers." Productivity analyses could therefore potentially be used to argue against treatment for some groups of patients.

Below is an edited excerpt from a DDW press release summarizing the study findings.

Curing Hepatitis C Could Yield Huge Economic Benefit

New research estimates $3.2 billion annual productivity savings in U.S. and five European countries

Washington, DC -- May 17, 2015 -- While a new generation of safer, more effective oral medications to treat hepatitis C patients may cost tens of thousands of dollars for a 12-week regimen, investing in these new therapies could generate savings estimated at more than $3.2 billion annually in the U.S. and five European countries, according to a new study (abstract 228) released today at Digestive Disease Week (DDW) 2015. These savings would have a significant economic impact on society.

The higher cure rate and lessened side effects of treating patients with an all-oral combination of ledipasvir and sofosbuvir (LDV/SOF) results in greatly reduced absenteeism and improved workplace productivity that can translate into enormous benefit, according to the new economic model used by researchers at Inova Fairfax Medical Campus, VA.

"From a clinical standpoint, we’ve long known about the devastating health impacts that chronic hepatitis C has on a patient," said Zobair Younossi, MD, chairman of the department of medicine at Inova and lead researcher on the study. "But given the significant side effects previously associated with treating the disease, notably fatigue and neuropsychiatric side effects, we were interested in looking at the impact of new treatments on patients’ ability to work, and in a broader sense, how this effects employers and overall economies." 

Researchers used data collected from more than 1,900 chronic hepatitis C patients treated with LDV/SOF, which has a cure rate of between 94 and 99 percent with minimal side effects. Older traditional treatments that included interferon and ribavirin were less effective and caused a variety of side effects, including fatigue, as well as flu-like symptoms, depression, and lowered blood cell counts.

Patients from the U.S. and Europe filled out questionnaires called the “Work Productivity and Activity Index -- Specific Health Problems" during clinical trials of LDV/SOF. The retrospective study tabulated reported absenteeism, as well as what researchers called "presenteeism," a measure of how productive an individual actually is while at work.

The researchers then built an economic model to estimate work productivity gains associated with curing genotype-1 chronic hepatitis C patients using LDV/SOF. The models were created for the U.S. and five European countries --France, Germany, Italy, Spain, and the United Kingdom (EU-5). The results indicated that reduced absenteeism and increased productivity would total approximately $2.67 billion for the U.S. and $556 million for the EU-5.

Dr. Younossi stressed that while these preliminary results are encouraging, he plans to conduct further research to examine data outside of the clinical trial setting in order to evaluate the real-world consequences of a hepatitis C cure on work productivity and associated economic gains. He believes that researchers are beginning to see the bigger picture when it comes to the impact of hepatitis C, which can cause severe liver damage and other long-term health effects called the "extrahepatic manifestations of the hepatitis C virus."

"Chronic hepatitis C is more than just a problem for the patient -- it has a ripple effect that impacts society at large. While previous reports have found the cost of these drugs as certainly significant, the long term benefits of curing patients with hepatitis C makes this a worthwhile investment. We must begin to look at chronic diseases, such as hepatitis C, from every angle, which should inspire progress in developing more tolerable and effective cures," added Dr. Younossi.

About DDW

Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 16-19, 2015, at Walter. E. Washington Convention Center, Washington, DC. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at www.ddw.org.

Follow us on Twitter @DDWMeeting; hashtag #DDW15.

5/18/15

Reference

ZM Younossi, N Smith, M Stepanova, et al. The Impact of Sustained Viral Eradication on the Work Productivity of Patients with Chronic Hepatitis C (CHC) from the Five Western European Countries and the United States. Digestive Disease Week 2015. Washington, DC, May 16-19, 2014. Abstract 228.

Other Source

DDW 2015. Curing Hepatitis C Could Yield Huge Economic Benefit. Press release. May 17, 2015.