Nationwide Socioeconomic Evaluation of Direct‐Acting Antivirals for Chronic Hepatitis C Virus Infection in Japan Between 2014 and 2023

Interferon-free direct-acting antivirals (DAAs), which are highly effective in eliminating hepatitis C virus (HCV), became available in Japan in 2014. This study aimed to estimate the nationwide socioeconomic outcomes of DAA therapy in Japan using publicly available records, including data from the hepatitis subsidy program and universal healthcare claims between fiscal years 2014 and 2023. Based on the standard dose of each DAA regimen, approximately 300,000 people were estimated to have been treated with DAA therapy by 2023, with a cumulative drug cost of at least 1.23 trillion Japanese yen (10.8 billion United States dollars). The main indication for DAA therapy was the initial treatment of chronic HCV infection without cirrhosis. The estimated cost and number of treated people peaked in 2015, followed by a declining trend. For most DAA regimens, annual prescriptions were the greatest in the same or the following year of approval. Sofosbuvir/ledipasvir and glecaprevir/pibrentasvir were the two most common regimens. The age of people treated with DAA therapy shifted towards younger people during the survey period, particularly in males. While the estimated prevalence of people treated with DAA therapy was higher in Western Japan, the estimated number of treated people and population in each prefecture showed a linear association (p < 0.001). Despite the large economic impact, the rapid uptake of DAA therapy suggests an active program of case finding and treatment with the goal of HCV elimination in Japan. Whereas the demographics of people receiving DAA therapy changed over time, treatments were provided uniformly across the nation.