Cost-effectiveness of direct-acting antiviral regimen ombitasvir/paritaprevir/ritonavir in treatment-naïve and treatment-experienced patients infected with chronic hepatitis C virus genotype 1b in Japan

Objective: This study compared the cost-effectiveness of chronic hepatitis C virus (HCV) genotype 1b (GT1b) therapy ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) vs daclatasvir?+?asunaprevir (DCV/ASV) and no treatment in patients without cirrhosis. Cost-effectiveness analyses (CEAs) that compared OBV/PTV/r against DCV/ASV and sofosbuvir/ledipasvir (SOF/LDV) in Y93H mutation-negative, GT1b patients with and without cirrhosis were also included.

Methods: A health state transition model was developed to capture the natural history of HCV. A CEA over a lifetime horizon was performed from the perspective of the public healthcare payer in Japan. Costs, health utilities, and rates of disease progression were derived from published studies. Sustained virologic response (SVR) rates of OBV/PTV/r and DCV/ASV were extracted from Japanese clinical trials. Analyses were performed for treatment-naïve and -experienced patients. Alternative scenarios and input parameter uncertainty on the results were tested.

Results: OBV/PTV/r exhibited superior clinical outcomes vs comparators. For OBV/PTV/r, DCV/ASV, and no treatment, the lifetime risk of decompensated cirrhosis in treatment-naïve patients without cirrhosis was 0.4%, 1.4%, and 9.2%, and hepatocellular carcinoma was 6.5%, 11.4%, and 49.9%, respectively. Quality-adjusted life years (QALYs) were higher in treatment-naïve and -experienced patients without cirrhosis treated with OBV/PTV/r (16.41 and 16.22) vs DCV/ASV (15.83 and 15.66) or no treatment (11.34 and 11.23). In treatment-naïve and -experienced patients without cirrhosis, the incremental cost-effectiveness ratios (ICERs) of OBV/PTV/r vs DCV/ASV were JPY 1,684,751/QALY and JPY 1,836,596/QALY, respectively; OBV/PTV/r was dominant compared with no treatment. In scenario analysis, including GT1b patients with and without cirrhosis who were Y93H mutation-negative, the ICER of OBV/PTV/r vs DCV/ASV was below the Japanese willingness-to-pay threshold of JPY 5 million/QALY, while the ICER of SOF/LDV vs OBV/PTV/r was above this threshold; thus, OBV/PTV/r was cost-effective.

Conclusion: OBV/PTV/r appears to be a cost-effective treatment for chronic HCV GT1b infection against DCV/ASV. OBV/PTV/r dominates no treatment in patients without cirrhosis.     

Public provision of private child goods

This paper analyzes the public provision of private goods for children in a politico-economic model with endogenous fertility. The government provides every child with goods that can also be purchased by parents in private markets, and the level of provision is determined by majority rule. Households with many children benefit from the public provision more than those with fewer children; thus, a political conflict arises between them. The distribution of the number of children across households, which is a crucial factor for determining which group is politically dominant, is endogenously determined by households' fertility decision. The sequential interaction between fertility and political decisions might lead to multiple equilibria: equilibrium with high fertility and low-private/public-spending ratio and equilibrium with low fertility and high-private/public-spending ratio. Our model could explain the large differences in fertility and structure of child-related spending across countries.     

A THEORY OF THE CROSS‐SECTIONAL FERTILITY DIFFERENTIAL: JOB HETEROGENEITY APPROACH

This article presents a theory of the cross‐sectional fertility differential, which produces the negative wage–fertility relationship based on job heterogeneity. Although evidence suggests the importance of job heterogeneity in the labor market, it has largely been ignored in theories of fertility choice. I show that a theory incorporating job heterogeneity requires only standard conditions on preferences to generate the negative wage–fertility relationship, and the negative relationship derived from the model is robust to changes in economic environments (e.g., public policy and technology). Furthermore, the theory reconciles the negative cross‐sectional wage–fertility relationship with various time‐series variations in aggregate fertility.     

The Galor–Weil gender-gap model revisited: from home to market

This paper develops an overlapping generations model that incorporates two-sector (market and non-market) production, gender heterogeneity, and fertility choice. We extend the gender-gap model of Galor and Weil (Am Econ Rev 86(3):374–387, 1996) by adding a third use of time, non-market work, into household time allocation. Our model can explain the joint evolution of production structure, household time allocation, and fertility broadly observed in the nineteenth and twentieth centuries in the Western world as part of a single process of economic development: (i) production shifted out of households and into the market, (ii) there was first an increase in the supply of male labor to the market, followed by an increase in the female labor supply; married-female participation in paid work outside the home dramatically increased in the latter half of the twentieth century, and (iii) there has been a two-century long secular decline in fertility, interrupted by a temporary rise in the mid-twentieth century (a baby boom). We also provide a quantitative analysis and examine how well our model replicates the patterns observed in U.S. data.