Elbasvir 50mg / Grazoprevir 100mg tablets

OBJECTIVES: Direct-acting antivirals (DAAs) have revolutionized hepatitis C (HCV) treatment, yet their high cost necessitates rigorous economic evaluation. Glecaprevir/Pibrentasvir (GLE/PIB) and Grazoprevir/Elbasvir (GZR/EBR) are two key, highly effective DAA regimens, but their comparative cost-effectiveness across different healthcare settings remains unclear. This study aims to systematically review and qualitatively synthesize the economic evidence for GLE/PIB and GZR/EBR, comparing them with each other and other relevant HCV treatments. METHODS: A systematic review was conducted by searching PubMed, Scopus, Embase, Science Direct, and the Cochrane Library for full economic evaluation studies published up to September 2025. The quality of included studies was assessed using the CHEERS checklist. Due to significant heterogeneity in study contexts, populations, and methodologies, a qualitative narrative synthesis was performed, and quantitative pooling of economic outcomes was avoided. RESULTS: A total of 20 economic evaluation studies were included. Both GLE/PIB and GZR/EBR were consistently found to be cost-effective or dominant strategies when compared to older interferon-based therapies. However, the five head-to-head studies comparing GLE/PIB and GZR/EBR yielded conflicting results: GLE/PIB was the economically preferred option in settings like Japan and Brazil, whereas GZR/EBR was favored in analyses from China and Hong Kong. This variability appears to be primarily driven by differences in local drug acquisition prices. CONCLUSION: Neither GLE/PIB nor GZR/EBR can be considered universally more cost-effective than the other. Both regimens represent valuable advancements over previous standards of care, but the optimal economic choice between them is highly context-dependent. These findings underscore the necessity of using local, setting-specific economic evaluations to inform clinical guidelines and reimbursement policies.

Abstract licence: CC BY-NC-ND

ObjectiveThis study aims to systematically review recent economic evaluations of elbasvir/grazoprevir (EBR/GZR) for chronic hepatitis C (CHC), to critically appraise the reporting quality and to summarize the results.MethodsA literature search was undertaken using Medline, Embase, the Cochrane Library, EconLit, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP to identify original articles containing economic evaluations of EBR/GZR for CHC published between 1 January 2000 and 31 December 2020. The Consolidated Health Economic Evaluation Reporting Standards statement was used to assess the quality of reporting of the articles.ResultsOf 93 articles identified, 13 studies fulfilled the inclusion criteria. These studies were conducted in 4 countries, and 8 active interventions were assessed. The target population was patients infected with CHC genotype 1 infection in all studies. Eight out of 13 studies that compared EBR/GZR vs. other direct antiviral agents suggested that EBR/GZR was generally more cost-effective or dominant than daclatasvir/asunaprevir (DCV/ASV), sofosbuvir/velpatasvir (SOF/VEL), ledipasvir/sofosbuvir (LDV/SOF), ombitasvir/paritaprevir/ritonavir + dasabuvir (3D) but not more cost-effective than glecaprevir/pibrentasvir (GLE/PIB). Two studies from China and one study from the USA that compared EBR/GZR vs. pegylated interferon and ribavirin (PegIFN/RBV) consistently indicated that EBR/GZR was generally more cost-effective than PegIFN/RBV. One study from Italy compared EBR/GZR with SOF + PegIFN/RBV and suggested that EBR/GZR had a lower cost and higher effectiveness. One study from France and one study from the USA confirmed that compared with non-therapy for patients with chronic kidney disease, EBR/GZR was cost-effective at commonly accepted current standards. All included studies were of good quality of reporting, with an average score of 21.9 (range 19-23).ConclusionEBR/GZR for CHC genotype 1 might be cost-effective or dominant compared with PegIFN/RBV and other direct antiviral agents (SOF/VEL, 3D, DCV/ASV, LDF/SOF) or non-therapy. However, under certain assumptions, EBR/GZR was not a cost-effective alternative for CHC patients vs. GLE/PIB.

Abstract licence: CC BY

BackgroundHepatitis C virus (HCV) infection is common in persons who inject drugs (PWID).ObjectiveTo evaluate elbasvir-grazoprevir in treating HCV infection in PWID.DesignRandomized, placebo-controlled, double-blind trial. (ClinicalTrials.gov: NCT02105688).SettingAustralia, Canada, France, Germany, Israel, the Netherlands, New Zealand, Norway, Spain, Taiwan, the United Kingdom, and the United States.Patients301 treatment-naive patients with chronic HCV genotype 1, 4, or 6 infection who were at least 80% adherent to visits for opioid agonist therapy (OAT).InterventionThe immediate-treatment group (ITG) received elbasvir-grazoprevir for 12 weeks; the deferred-treatment group (DTG) received placebo for 12 weeks, no treatment for 4 weeks, then open-label elbasvir-grazoprevir for 12 weeks.MeasurementsThe primary outcome was sustained virologic response at 12 weeks (SVR12), evaluated separately in the ITG and DTG. Other outcomes included SVR24, viral recurrence or reinfection, and adverse events.ResultsThe SVR12 was 91.5% (95% CI, 86.8% to 95.0%) in the ITG and 89.5% (95% CI, 81.5% to 94.8%) in the active phase of the DTG. Drug use at baseline and during treatment did not affect SVR12 or adherence to HCV therapy. Among 18 patients with posttreatment viral recurrence through 24-week follow-up, 6 had probable reinfection. If the probable reinfections were assumed to be responses, SVR12 was 94.0% (CI, 89.8% to 96.9%) in the ITG. One patient in the ITG (1 of 201) and 1 in the placebo-phase DTG (1 of 100) discontinued treatment because of an adverse event.LimitationThese findings may not be generalizable to PWID who are not receiving OAT, nor do they apply to persons with genotype 3 infection, a common strain in PWID.ConclusionPatients with HCV infection who were receiving OAT and treated with elbasvir-grazoprevir had high rates of SVR12, regardless of ongoing drug use. These results support the removal of drug use as a barrier to interferon-free HCV treatment for patients receiving OAT.Primary funding sourceMerck & Co.

Abstract licence: CC BY-NC-ND