Original Research5 May 2015
    Author, Article, and Disclosure Information



    Chronic infection with hepatitis C virus (HCV) genotype 2 or 3 can be treated with sofosbuvir without interferon. Because sofosbuvir is costly, its benefits should be compared with the additional resources used.


    To estimate the cost-effectiveness of sofosbuvir-based treatments for HCV genotype 2 or 3 infection in the United States.


    Monte Carlo simulation, including deterministic and probabilistic sensitivity analyses.

    Data Sources:

    Randomized trials, observational cohorts, and national health care spending surveys.

    Target Population:

    8 patient types defined by HCV genotype (2 vs. 3), treatment history (naive vs. experienced), and cirrhosis status (noncirrhotic vs. cirrhotic).

    Time Horizon:





    Sofosbuvir-based therapies, pegylated interferon–ribavirin, and no therapy.

    Outcome Measures:

    Discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).

    Results of Base-Case Analysis:

    The ICER of sofosbuvir-based treatment was less than $100 000 per QALY in cirrhotic patients (genotype 2 or 3 and treatment-naive or treatment-experienced) and in treatment-experienced noncirrhotic patients but was greater than $200 000 per QALY in treatment-naive noncirrhotic patients.

    Results of Sensitivity Analysis:

    The ICER of sofosbuvir-based therapy for treatment-naive noncirrhotic patients with genotype 2 or 3 infection was less than $100 000 per QALY when the cost of sofosbuvir was reduced by approximately 40% and 60%, respectively. In probabilistic sensitivity analyses, cost-effectiveness conclusions were robust to uncertainty in treatment efficacy.


    The analysis did not consider possible benefits of preventing HCV transmission.


    Sofosbuvir provides good value for money for treatment-experienced patients with HCV genotype 2 or 3 infection and those with cirrhosis. At their current cost, sofosbuvir-based regimens for treatment-naive noncirrhotic patients exceed willingness-to-pay thresholds commonly cited in the United States.

    Primary Funding Source:

    National Institute on Drug Abuse and National Institute of Allergy and Infectious Diseases.


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