Background and aims: To allocate treatment resources for chronic hepatitis C (CHC) genotype 1 naive patients, we performed a cost-effectiveness analysis of Boceprevir (BOC) and Telaprevir (TVR) based triple therapy according to different patient selection strategies. Methods: A semi-Markov model of CHC natural history and progression toward end stage liver diseases (decompensated cirrhosis, HCC and liver transplantation) was built. Model health states were defined by METAVIR fibrosis stages (F0–F4), and complications of cirrhosis. We considered 3 selection strategies based on fibrosis stage: (1) treat all patients with F1–F4 fibrosis, (2) only F2–F4 and (3) only F3–F4. For each strategy, TVR IL28B-guided and BOC RVRguided therapy was applied. The model assessed the costs and outcomes, including QALYs, Life Years and the number of End Stage Liver Diseases developed or Death (ESLD-D), using lifetime as time horizon and adopting the NHS perspective. An alternative simulation was performed using 5 year as time horizon, as coherent with upcoming main changes in standard of care (all-oral protocols). Results: The F3–F4 selection strategy proved the least expensive and the least effective. Adopting the lifetime horizon, F1–F4 strategy was cost-effective with an ICER of D 5132.13 for QALY, in TVR IL28B-guided, and D 7042.49 for QALY, in BOC RVR-guided therapy. In the 5 year scenario, only F3–F4 strategy showed costeffectiveness, while the F1–F4 strategy was not cost-effective, with an ICER of D 1,818,679 (TVR IL28B guided) and D 1866.437 (BOC RVR-guided) for each ESLD-D avoided. Conclusions: The present simulation study demonstrated that treating all CHC patients regardless of fibrosis stage is cost-effective in a lifetime horizon scenario. In a more realistic 5-year time horizon scenario, to treat patients with advanced fibrosis and cirrhosis was the only strategy to show cost-effectiveness.
Cortesi, P., Ciaccio, A., Rota, M., De Salvia, S., Okolicsanyi, S., Vinci, M., et al. (2014). Management of chronic hepatitis C (Chc) genotype 1 treatment-naïve patients in an era of rising opportunities and costs: A cost-effectiveness analysis. DIGESTIVE AND LIVER DISEASE, 46(Suppl 1), e11-e11 [10.1016/j.dld.2014.01.028].
Management of chronic hepatitis C (Chc) genotype 1 treatment-naïve patients in an era of rising opportunities and costs: A cost-effectiveness analysis
CORTESI, PAOLO ANGELO;CIACCIO, ANTONIO;ROTA, MATTEO;OKOLICSANYI, STEFANO;MANTOVANI, LORENZO GIOVANNI;STRAZZABOSCO, MARIO
2014
Abstract
Background and aims: To allocate treatment resources for chronic hepatitis C (CHC) genotype 1 naive patients, we performed a cost-effectiveness analysis of Boceprevir (BOC) and Telaprevir (TVR) based triple therapy according to different patient selection strategies. Methods: A semi-Markov model of CHC natural history and progression toward end stage liver diseases (decompensated cirrhosis, HCC and liver transplantation) was built. Model health states were defined by METAVIR fibrosis stages (F0–F4), and complications of cirrhosis. We considered 3 selection strategies based on fibrosis stage: (1) treat all patients with F1–F4 fibrosis, (2) only F2–F4 and (3) only F3–F4. For each strategy, TVR IL28B-guided and BOC RVRguided therapy was applied. The model assessed the costs and outcomes, including QALYs, Life Years and the number of End Stage Liver Diseases developed or Death (ESLD-D), using lifetime as time horizon and adopting the NHS perspective. An alternative simulation was performed using 5 year as time horizon, as coherent with upcoming main changes in standard of care (all-oral protocols). Results: The F3–F4 selection strategy proved the least expensive and the least effective. Adopting the lifetime horizon, F1–F4 strategy was cost-effective with an ICER of D 5132.13 for QALY, in TVR IL28B-guided, and D 7042.49 for QALY, in BOC RVR-guided therapy. In the 5 year scenario, only F3–F4 strategy showed costeffectiveness, while the F1–F4 strategy was not cost-effective, with an ICER of D 1,818,679 (TVR IL28B guided) and D 1866.437 (BOC RVR-guided) for each ESLD-D avoided. Conclusions: The present simulation study demonstrated that treating all CHC patients regardless of fibrosis stage is cost-effective in a lifetime horizon scenario. In a more realistic 5-year time horizon scenario, to treat patients with advanced fibrosis and cirrhosis was the only strategy to show cost-effectiveness.
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