{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T13:12:25Z","timestamp":1775567545155,"version":"3.50.1"},"reference-count":60,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2022,6,7]],"date-time":"2022-06-07T00:00:00Z","timestamp":1654560000000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Low-cost generic direct-acting antiviral (DAA) regimens for treatment of hepatitis C virus (HCV) are available in several low-income\/middle-income countries, important for treatment scale-up. This study evaluated the cost-effectiveness of genotype-dependent and pan-genotypic DAA regimens in Iran as an example of a resource-limited setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov model was developed to simulate HCV natural history. A decision tree was developed for HCV treatment, assuming four scenarios, including scenario 1: genotyping, sofosbuvir\/ledipasvir (SOF\/LDV) for genotype 1, and sofosbuvir\/daclatasvir (SOF\/DCV) for genotype 3; scenario 2: genotyping, SOF\/LDV for genotype 1, and sofosbuvir\/velpatasvir (SOF\/VEL) for genotype 3; scenario 3: no genotyping and SOF\/DCV for all; and scenario 4: no genotyping and SOF\/VEL for all. A 1-year cycle length was used to calculate the cumulative cost and effectiveness over a lifetime time horizon. We calculated quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) using a health system perspective. Costs were converted to US dollars using purchasing power parity exchange rate ($PPP). All costs and outcomes were discounted at an annual rate of 3%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among people with no cirrhosis, scenario 3 had the minimum cost, compared with which scenario 4 was cost-effective with an ICER of 4583 $PPP per QALY (willingness-to-pay threshold: 9,311 $PPP per QALY). Among both people with compensated or decompensated cirrhosis, scenario 4 was cost saving. In sensitivity analysis, scenario 4 would be also cost-saving among people with no cirrhosis provided a 39% reduction in the cost of 12 weeks SOF\/VEL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Initiating all patients on pan-genotypic generic DAA regimens with no pretreatment genotyping was cost-effective compared with scenarios requiring pretreatment HCV genotype tests. Among generic pan-genotypic DAA regimens, SOF\/VEL was cost-effective, for people with no cirrhosis and cost-saving for those with cirrhosis.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-058757","type":"journal-article","created":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T15:13:24Z","timestamp":1654701204000},"page":"e058757","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5546-2876","authenticated-orcid":false,"given":"Mohammad","family":"Tasavon Gholamhoseini","sequence":"first","affiliation":[]},{"given":"Heidar","family":"Sharafi","sequence":"additional","affiliation":[]},{"given":"Helena","family":"HL Borba","sequence":"additional","affiliation":[]},{"given":"Seyed Moayed","family":"Alavian","sequence":"additional","affiliation":[]},{"given":"Asma","family":"Sabermahani","sequence":"additional","affiliation":[]},{"given":"Behzad","family":"Hajarizadeh","sequence":"additional","affiliation":[]}],"member":"239","published-online":{"date-parts":[[2022,6,8]]},"reference":[{"key":"2022063019502852000_12.6.e058757.1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S2468-1253(16)30181-9","article-title":"Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study","volume":"2","author":"","year":"2017","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2022063019502852000_12.6.e058757.2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.076646"},{"key":"2022063019502852000_12.6.e058757.3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ197"},{"key":"2022063019502852000_12.6.e058757.4","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/S2468-1253(16)30075-9","article-title":"Hepatitis C treatment as prevention: evidence, feasibility, and challenges","volume":"1","author":"Hajarizadeh","year":"2016","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2022063019502852000_12.6.e058757.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2015.01.004"},{"key":"2022063019502852000_12.6.e058757.6","doi-asserted-by":"crossref","first-page":"100001","DOI":"10.1016\/j.jve.2020.06.001","article-title":"Price of a hepatitis C cure: cost of production and current prices for direct-acting antivirals in 50 countries","volume":"6","author":"Barber","year":"2020","journal-title":"J Virus Erad"},{"key":"2022063019502852000_12.6.e058757.7","doi-asserted-by":"crossref","first-page":"S758","DOI":"10.1093\/infdis\/jiaa366","article-title":"Novel hepatitic C virus (HCV) diagnosis and treatment delivery systems: facilitating HCV elimination by thinking outside the clinic","volume":"222","author":"Bajis","year":"2020","journal-title":"J Infect Dis"},{"key":"2022063019502852000_12.6.e058757.8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0145953"},{"key":"2022063019502852000_12.6.e058757.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.08.018"},{"key":"2022063019502852000_12.6.e058757.10","doi-asserted-by":"crossref","DOI":"10.5812\/hepatmon.37234","article-title":"Liver disease burden of hepatitis C virus infection in Iran and the potential impact of various treatment strategies on the disease burden","volume":"16","author":"Hajarizadeh","year":"2016","journal-title":"Hepat Mon"},{"key":"2022063019502852000_12.6.e058757.11","doi-asserted-by":"crossref","unstructured":"Hajarizadeh B . 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