@article {WongE97, author = {William W. L. Wong and Karen M. Lee and Sumeet Singh and George Wells and Jordan J. Feld and Murray Krahn}, title = {Drug therapies for chronic hepatitis C infection: a cost-effectiveness analysis}, volume = {5}, number = {1}, pages = {E97--E108}, year = {2017}, doi = {10.9778/cmajo.20160161}, publisher = {Canadian Medical Association Open Access Journal}, abstract = {Background: Before 2011, pegylated interferon plus ribavirin was the standard therapy for chronic hepatitis C. Interferon-free direct-acting antiviral agents were then approved. Although these treatments appear to be more effective, they are substantially more expensive. In anticipation of the need for information regarding the comparative cost-effectiveness of new regimens in a recent therapeutic review, we conducted the analysis to inform listing decision in Canada.Methods: A state-transition model was developed in the form of a cost-utility analysis. Regimens included in the analysis were comprehensive. The cohort under consideration had a mean age of 50 years. The cohort was defined by treatment status and cirrhosis status. Inputs for the model were derived from published sources and validated by clinical experts.Results: For each genotype 1 population, at least 1 of the interferon-free agents appeared to be economically attractive compared with pegylated interferon-ribavirin, at a willingness-to-pay of $50 000 per quality-adjusted life-year. The drug that was the most cost-effective varied by population. For genotype 2-4 population, the direct-acting antiviral therapies appeared not to be economically attractive compared with pegylated interferon-ribavirin for the treatment-naive; however, there were direct-acting antiviral therapies that appeared to be attractive when compared with no treatment for the treatment-experienced.Interpretation: Public health policy should be informed by consideration of health benefit, social and ethical values, feasibility and cost-effectiveness. Our analysis assists the development of reimbursements and policies for interferon-free direct-acting antiviral agent regimens for chronic hepatitis C infection by informing the last criterion. Considering the rapid development of treatments for chronic hepatitis C, further update and expanded reviews will be necessary.}, URL = {https://www.cmajopen.ca/content/5/1/E97}, eprint = {https://www.cmajopen.ca/content/5/1/E97.full.pdf}, journal = {Canadian Medical Association Open Access Journal} }