6533b86ffe1ef96bd12cd2d4
RESEARCH PRODUCT
Cost effectiveness of boceprevir or telaprevir for previously treated patients with genotype 1 chronic hepatitis C.
Salvatore PettaGiuseppe CabibboAntonio GasbarriniAntonio CraxìMatteo RuggeriMarco EneaCalogero CammàAlfredo AlbertiGiuseppe CabibboRaffaele BrunoAntonio Gasbarrinisubject
MaleTVRCost effectivenessCost-Benefit AnalysisPIPeginterferon-alfaBOCHepacivirusBOC Boceprevir CHC Cost-effectiveness DT G1 ICER NR PAR PI PegIFN RBV RR TVR Telaprevir boceprevir chronic hepatitis C dual therapy genotype 1 incremental cost-effectiveness ratio non-response partial response pegylated interferon protease inhibitors relapse ribavirin telaprevirTelaprevirTelaprevirchemistry.chemical_compoundPegylated interferonnon-responseboceprevirincremental cost-effectiveness ratioRBVTreatment FailureDThealth care economics and organizationsRandomized Controlled Trials as Topicrelapsecost effectivenessICERMiddle AgedMarkov ChainsModels EconomicItalyQuality-Adjusted Life YearsSettore SECS-P/02 - politica economicaSettore SECS-S/01 - StatisticaIncremental cost-effectiveness ratioOligopeptidesmedicine.drugmedicine.medical_specialtyGenotypeProlineribavirinSettore MED/12 - GASTROENTEROLOGIAprotease inhibitorsNRRRAntiviral AgentsInternal medicineBoceprevirG1medicineHumanschronic hepatitis Cpegylated interferongenotype 1Hepatologybusiness.industryRibavirindual therapyHepatitis C ChronicQuality-adjusted life yearSurgeryCHCPegIFNchemistryCost-effectivenesspartial responsebusinessPARdescription
Background & Aims Randomised controlled trials (RCTs) show that triple therapy (TT) with peginterferon alfa, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of genotype 1 (G1) chronic hepatitis C (CHC) patients with previous relapse (RR), partial response (PAR), and null-response (NR). We assess the cost-effectiveness of TT compared to no therapy in the treatment of patients previously treated with G1 CHC. Methods The available published literature provided the data source. The target population was made up of previously treated Caucasian patients with G1 CHC and these were evaluated over a lifetime horizon by Markov model. The study was carried out from the perspective of the Italian National Health Service. Outcomes included discounted costs (in euro at 2012 value), life years gained (LYG), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER).The robustness of the results was evaluated by one-way deterministic and multivariable probabilistic sensitivity analyses. Results In RR patients, ICER per LYG compared to no therapy was €9555 for BOC-LEAD-IN-RR and €7910 for TVR-LEAD-IN-RR, being BOC dominated by TVR. In PAR patients, ICER for LYG was €11,947 for BOC-LEAD-IN-PAR and €14,931 for TVR-PAR, being TVR cost-effective compared to BOC (ICER for QALY €22,258). In NR patients, ICER for LYG was €26,499 for TVR-LEAD-IN-NR. The models were sensitive to likelihood of sustained virological response and to BOC/TVR prices. Conclusions 1st generation HCV PI is highly cost-effective compared to no therapy in RR and PAR G1 CHC patients. TVR dominated BOC in RR, and was cost-effective compared to BOC in PAR patients. In NR patients an assessment of the response after a lead-in period should be performed to improve safety and cost-effectiveness.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2013-01-01 |