Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2019; 11(5): 421-441
Published online May 27, 2019. doi: 10.4254/wjh.v11.i5.421
Hepatitis C virus cure with direct acting antivirals: Clinical, economic, societal and patient value for China
Qing Xie, Jian-Wei Xuan, Hong Tang, Xiao-Guang Ye, Peng Xu, I-Heng Lee, Shan-Lian Hu
Qing Xie, Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Jian-Wei Xuan, Health Economic Research Institute, School of Pharmacy, Sun Yat-Sen University, Guangzhou 510006, Guangdong Province, China
Hong Tang, Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Xiao-Guang Ye, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
Peng Xu, Gilead Sciences Inc, Shanghai 200122, China
I-Heng Lee, Gilead Sciences Inc, Foster City, CA 94404, United States
Shan-Lian Hu, School of Public Health, Fudan University, Shanghai 200032, China
Shan-Lian Hu, Shanghai Health Development Research Center, Shanghai 200032, China
Author contributions: All authors contributed to this paper with conception and design of the study, literature review and analysis, critical revision and editing, and final approval of the version to be published; all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Conflict-of-interest statement: Xie Q served as adviser, speaker or advisory board member for F Hoffmann-La Roche, Bristol-Myers Squibb, Novartis Pharmaceutical, MSD, and Gilead Sciences; Xuan JW has no potential conflicts of interest; Tang H served as adviser, speaker or advisory board member for MSD, La Roche, Bristol-Myers Squibb, Novartis Pharmaceutical, and Gilead Sciences; Ye XG served as speaker or adviser for GSK, F Hoffmann-La Roche, Bristol-Myers Squibb, Novartis Pharmaceutical, MSD, and Gilead Sciences; Xu P employee of Gilead Sciences. Lee IH employee of Gilead Sciences; Hu SL served as speaker or adviser for Gilead Sciences.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Shan-Lian Hu, MD, MSc, Professor, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China.
Telephone: +86-21-65642222
Received: December 28, 2018
Peer-review started: December 29, 2018
First decision: March 5, 2019
Revised: April 5, 2019
Accepted: April 19, 2019
Article in press: April 19, 2019
Published online: May 27, 2019

About 10 million people in China are infected with hepatitis C virus (HCV), with the seroprevalence of anti-HCV in the general population estimated at 0.6%. Delaying effective treatment of chronic hepatitis C (CHC) is associated with liver disease progression, cirrhosis, hepatocellular carcinoma, and liver-related mortality. The extrahepatic manifestations of CHC further add to the disease burden of patients. Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society. Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease. Traditionally, pegylated-interferon plus ribavirin (PR) was the standard of care. However, a substantial number of patients are ineligible for PR treatment, and only 40%–75% achieved sustained virologic response. Furthermore, PR is associated with impairment of patient-reported outcomes (PROs), high rates of adverse events, and poor adherence. With the advent of direct acting antivirals (DAAs), the treatment of CHC patients has been revolutionized. DAAs have broader eligible patient populations, higher efficacy, better PRO profiles, fewer adverse events, and better adherence rates, thereby making it possible to cure a large proportion of all CHC patients. This article aims to provide a comprehensive evaluation on the value of effective, curative hepatitis C treatment from the clinical, economic, societal, and patient experience perspectives, with a focus on recent data from China, supplemented with other Asian and international experiences where China data are not available.

Keywords: Hepatitis C, Value of cure, Sustained virologic response, End stage liver disease, Prevention of transmission, Cost-effectiveness, Productivity, Societal value, Patient-reported outcomes

Core tip: Chronic hepatitis C is a systemic disease that manifests both hepatically and extrahepatically, leading to impaired patient-reported outcomes (PROs) and huge economic burden on the healthcare system and society. Direct acting antivirals are effective hepatitis C therapies that improve PROs and have broad eligible patient populations, good efficacy, few adverse events, and high adherence rates. Sustained virologic response is associated with improved clinical outcomes and increased work productivity. Curative therapies for hepatitis C was of substantial societal and economic value because they reduce productivity loss and avoid the management costs associated with advanced liver disease and extrahepatic manifestations.