Economic evaluation of alternative hepatitis C treatment options: a post hoc analysis of the VIETNARMS trial

Journal article

Background
Hepatitis C remains a leading cause of liver disease worldwide, and access to Direct-Acting Antiviral (DAA) treatment remains limited in many settings. Alternative treatment strategies that require fewer tablets and clinical visits could help improve equitable access, and new approaches have recently been found to be non-inferior in producing sustained viral suppression.

Methods
We did a cost-minimization analysis of alternative treatment options for non-cirrhotic patients evaluated in the VIETNARMS trial (ISRCTN61522291), conducted between 19/06/2020 and 10/05/2023 in Vietnam. These were: (i) ‘response guided’ (which adjusts treatment duration based on 1-week viral load); (ii) ‘induction maintenance’ (which reduces the dosing frequency in later weeks of treatment); and (iii) ‘Peg-IFN+DAA’ (4 weeks of DAAs combined with four weekly doses of PEGylated interferon (Peg-IFN). The primary outcome was the cost per cure. A disaggregated societal perspective was adopted, including stratification for the healthcare provider and patient costs.

Findings
The three alternative treatment strategies were projected to have lower costs per cure than standard 12-week DAA treatment in the base-case scenario: US dollars 202 (15%) less for ‘response guided’, US dollars 234 (18%) less for ‘induction maintenance’, and US dollars 163 (12%) less for ‘PegIFN+DAA’. However, the potential for cost savings, and which strategy had the lowest cost per cure, depended on the assumed cost of DAA drugs: the strategy with the lowest cost per cure was generally ‘induction maintenance’ when DAA drug costs for a standard treatment course were under US dollars 1,000, but Peg-IFN+DAA when DAA costs exceeded US dollars 1,500. In some scenarios, lower costs per cure were achieved through reduced health system expenditures, despite increased costs to patients.

Interpretation
Alternative strategies for Hepatitis C treatment could reduce costs for providers and patients. As this is highly dependent on the variable costs of DAAs, approaches should be fit carefully to the prevailing context.

Funding
Wellcome Trust, Medical Research Council.

Authors: Turner, HC; Admed, S; Nguyen, HA; Hung, LM; Van Nuil, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: eClinicalMedicine
• Volume: 95
• Article number: 103969
• Publication date: 2026-05-07
• Acceptance date: 2026-04-20
• DOI: 10.1016/j.eclinm.2026.103969
• EISSN: 2589-5370
• Language: English
• Keywords: hepatitis C; DAA; economic evaluation; cost; cost-minimization analysis; treatment strategies