The challenges of administering a new treatment: the case of direct-acting antivirals for hepatitis C virus

Objectives: We develop a patient prioritization scheme for treating patients infected with hepatitis C virus (HCV) and study under which scenarios it outperforms the current practices in Spain and Chile. Study design: We use simulation to evaluate the performance of prioritization rules under two HCV patient cohorts, constructed using secondary data of public records from Chile and Spain, during 2015–2016. Methods: We use the results of a mathematical model, which determines individual optimal HCV treatment policies as an input for constructing a patient prioritization rule, when limited resources are present. The prioritization is based on marginal analysis on cost increases and health-outcome gains. We construct the Chilean and Spanish case studies and used Monte Carlo simulation to evaluate the performance of our methodology in these two scenarios. Results: The resulting prioritizations for the Chilean and Spanish patients are similar, despite the significant differences of both countries, in terms of epidemiological profiles and cost structures. Furthermore, when resources are scarce compared with the number of patients in need of the new drug, our prioritization significantly outperforms current practices of treating sicker patients first, both in terms of cost and healthcare indicators: for the Chilean case, we have an increase in the quality-adjusted life years (QALYs) of 0.83 with a cost reduction of 8176 euros per patient, with a budget covering 2.5% of the patients in the cohort. This difference slowly decreases when increasing the available resources, converging to the performance indicators obtained when all patients are treated immediately: for the Spanish case, we have a decrease in the QALYs of 0.17 with a cost reduction of 1134 euros per patient, with a budget covering 20% of the patients in the cohort. Conclusion: Decision science can provide useful analytical tools for designing efficient public policies that can excel in terms of quantitative health performance indicators.