Willingness to pay for innovation: the case of the anti-HCV drugs from the Italian National Health Service perspective

Disponibilità a pagare e innovazione: il caso dei farmaci anti-HCV nel Sistema Sanitario Italiano

Abstract

Introduction The hepatitis C virus (HCV) induces several pathological conditions with a substantial medical and economic burden. Currently licensed treatments for HCV infection include pegylated and standard interferon alpha (IFN), ribavirin (RBV), the protease inhibitors boceprevir, telaprevir, and boceprevir. A new scenario of therapy for HCV infection is being established following new treatments approval. The aim of this study is to evaluate new strategies long-term health outcomes and the willingness to pay for new anti-HCV treatments from the Italian societal perspective. Methods A multistate morbidity-mortality model was developed to estimate the infection progression in a theoretical cohort of Italian subjects. The Markov model considered 12 health states (F0, F1, F2, F3, Compensated cirrhosis (F4), SVR, decompensated cirrhosis, HCC, Transplantation (1 year), Transplantation (years later), HCV-related death and death from other causes) and 42 transition probabilities. The model was fed with data from national and international literature. The effectiveness of the new treatment strategies was hypothesized taking into account a literature review of clinical trials of innovative drugs that in the near future will be available in Italy. Estimates were also obtained for the cumulative number of HCV-related disease cases and the direct and indirect medical costs that will be avoided because of the increased effectiveness of new treatments. Results The cohort of subjects with chronic HCV in 2013 contained 267,190 subjects; of these about 17,600 patients F3-F4 are treated with drug therapy. The model predicted that the cumulative cases of HCV-related diseases prevented because of the larger effectiveness of the new treatments amounted to 47,433 after 7 years, 156,507 after 17 years, 256,942 after 27 years. The direct net medical costs, excluding the drug cost, amounted to € 18.13, € 72.33 and € 143.24 millions after 7, 17 and 27 years respectively, plus € 166.51, € 950.3 and € 551.53 millions attributable to indirect costs avoided, for the same time span. Furthermore, it was estimated that each patient treated with new drugs would save about € 12,000 in terms of direct costs, and € 4,000 in terms of indirect costs. Conclusion This model is the first attempt to estimate the saving that use of new anti-HCV drugs would cause, which may increase the NHS willingness to pay for the acquisition of such new drugs. An important share of the cost per treated patient can be balanced with the reduction of direct and indirect costs caused by the greater effectiveness of new treatments.