Project update: Ledipasvir-sofosbuvir for treating chronic hepatitis C

The FAD has been published for this appraisal, with differing recommendations depending on genotype, previous treatment and cirrhosis status.  HEDS provided the independent assessment.  In addition to the overall critical appraisal of searches, effectiveness evidence and cost-effectiveness evidence, additional analyses were undertaken on the following:

1. Development of an ERG-preferred base case using “unblended” EMA-recommended treatment durations for LDV/SOF(+/-RBV)
2. Examination of alternative EMA-recommended treatment durations for LDV/SOF
3. Use of alternative transition probabilities based on the previous sofosbuvir STA model
4. Use of UK valued on-treatment utility increment derived by Wright et al
5. Use of shorter time horizons (5-years and 10-years) to dampen assumptions regarding no re-infection
6. Threshold analysis for SVR rates of the comparators

These highlight issues that will undoubtedly be relevant to upcoming appraisals, including, choice of transition and utility values, alternative treatment durations being appraised incrementally and the impact of reinfection on the ICER.

The HEDS team were Praveen Thokala, Emma Simpson, Paul Tappenden and John Stevens.