6533b7d3fe1ef96bd1260a69
RESEARCH PRODUCT
Modeling cost-effectiveness and health gains of a âuniversalâ versus âprioritizedâ hepatitis C virus treatment policy in a real-life cohort
La KondiliF RomanoFr RolliM RuggeriS RosatoMr BrunettoAl ZignegoA CiancioA Di LeoG RaimondoC FerrariG TalianiG BorgiaTa SantantonioP BlancGb GaetaA GasbarriniL ChessaEm ErneE VillaD IeluzziFp RussoP AndreoneM VinciC CoppolaL ChemelloS MadoniaG VerucchiM PersicoM ZuinM PuotiA AlbertiG NardoneM MassariG MontaltoG FotiMg RumiMg QuarantaA CicchettiA CraxìS Vella Piter Collaborating Groupsubject
hepatitis C virusPediatricsCost effectivenessViral HepatitisAdult; Aged; Aged 80 and over; Antiviral Agents; Cohort Studies; Cost-Benefit Analysis; Health Policy; Hepatitis C; Humans; Middle Aged; Young Adult; Models Economic; HepatologyCost-Benefit AnalysisDirect-acting antiviralAdult; Aged; Aged 80 and over; Antiviral Agents; Cohort Studies; Cost-Benefit Analysis; Health Policy; Hepatitis C; Humans; Middle Aged; Young Adult; Models EconomicCohort StudiesLiver disease0302 clinical medicineModelsHealth careantiviral therapy80 and overincremental cost-effectiveness ratiohealth care economics and organizationsHCV cost -effectivenessAged 80 and overDirect-acting antiviral hepatocellular carcinoma hepatitis C virus incremental cost-effectiveness ratio interferon quality-adjusted life-years sustained virological response willingness to payCost–benefit analysis030503 health policy & servicesquality-adjusted life-yearsHealth PolicyHepatitis Chepatocellular carcinomainterferonMiddle AgedHepatitis CModels EconomicAdult; Aged; Aged 80 and over; Antiviral Agents; Cohort Studies; Cost-Benefit Analysis; Health Policy; Hepatitis C; Humans; Middle Aged; Young Adult; Models Economic; Hepatology; HCV; antiviral therapy; cost-effectiveness; real-life cohortCohortHCV030211 gastroenterology & hepatologyOriginal Articlesustained virological response0305 other medical scienceCohort studyHumanAdultmedicine.medical_specialtyEconomicAntiviral AgentsNO03 medical and health sciencesYoung Adultreal-life cohortmedicineHumansCost-Benefit Analysicost-effectivenessHealth policyAgedAntiviral AgentHepatologybusiness.industryOriginal Articlesmedicine.diseaseSurgeryCohort Studiebusinesswillingness to paydescription
We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virusâinfected patients: policy 1, âuniversal,â treat all patients, regardless of fibrosis stage; policy 2, treat only âprioritizedâ patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virusâinfected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policiesâ cost-effectiveness. The patientsâ age and fibrosis stage, assumed DAA treatment cost of â¬15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of â¬30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was â¬8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was â¬19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 postâsustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (â¬15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (Hepatology 2017;66:1814â1825).
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2017-10-01 |