Centering the Patient Perspective in Hepatitis C Treatment Evaluation

Joey Mattingly, PhD, PharmD

In recent years, a growing chorus of patients, providers, and health economics researchers have been calling for a new approach to value assessment that incorporates patient-informed elements of value alongside traditional measures of outcomes and associated costs. A recent analysis from the PAVE Center at the University of Maryland School of Pharmacy, confirms what many already suspected: traditional value assessment models only include about 25% of the value elements that patients care about.

Value assessments of Hepatitis C treatments are no exception. Recent innovations in drug therapy have led to newer class of drugs known as Direct Acting Antivirals (DAAs) used to treat chronic hepatitis C virus (HCV).  However, existing value assessments of DAAs make little use of patient-engagement methods and instead focus solely on the cure while failing to address other challenges faced by HCV-positive patients.

My team at PAVE sought to change this. With the support of the Patient-Centered Outcomes Research Institute’s (PCORI) Pipeline to Proposal program, we convened a stakeholder advisory board that included several patients diagnosed with the disease. The findings from that panel helped guide my team as we constructed a novel economic model to assess the value of HCV treatments that incorporated two new patient-informed treatment outcomes — infected life-years and workdays missed. The results are illustrated in the infographic below:

Using these new measures, our model found that DAA-treated patients, when compared to patients who did not receive DAA treatments, had fewer infected life-years and fewer workdays missed over a 10-year time horizon. Further, DAAs were also found to reduce societal costs compared to non-treatment when accounting for patient/caregiver time and lost wages. And for payers, our model found that the use of DAAs resulted in better outcomes at a cost below historic cost-per-quality-adjusted-life year (QALY) thresholds used to assess treatment value.

We know that individuals living with HCV face psychological and socioeconomic challenges that extend well beyond laboratory tests for the presence of a virus or damage to the liver. It’s about time assessments of these therapies properly account for these challenges and present a more meaningful representation of their value.

Joey Mattingly, PhD, PharmD, MBA is an associate professor of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy and Director of Operations for the Patient-Driven Values in Healthcare Evaluation (PAVE) Center. PAVE is a PhRMA Foundation Center of Excellence.