Abstract

BACKGROUND
Chronic hepatitis C virus is difficult to treat and affects approximately 3 million Americans. Protease inhibitors increase the effectiveness of standard therapy, but they are costly. A genetic assay may identify patients most likely to benefit from this treatment advance.
OBJECTIVE
To assess the cost-effectiveness of new protease inhibitors and an interleukin (IL)-28B genotyping assay for treating chronic hepatitis C virus.
DESIGN
Decision-analytic Markov model.
DATA SOURCES
Published literature and expert opinion.
TARGET POPULATION
Treatment-naive patients with chronic, genotype 1 hepatitis C virus monoinfection.
TIME HORIZON
Lifetime.
PERSPECTIVE
Societal.
INTERVENTION
Strategies are defined by the use of IL-28B genotyping and type of treatment (standard therapy [pegylated interferon with ribavirin]; triple therapy [standard therapy and a protease inhibitor]). Interleukin-28B-guided triple therapy stratifies patients with CC genotypes to standard therapy and those with non-CC types to triple therapy.
OUTCOME MEASURES
Discounted costs (in 2010 U.S. dollars) and quality-adjusted life-years (QALYs); incremental cost-effectiveness ratios.
RESULTS OF BASE-CASE ANALYSIS
For patients with mild and advanced fibrosis, universal triple therapy reduced the lifetime risk for hepatocellular carcinoma by 38% and 28%, respectively, and increased quality-adjusted life expectancy by 3% and 8%, respectively, compared with standard therapy. Gains from IL-28B-guided triple therapy were smaller. If the protease inhibitor costs $1100 per week, universal triple therapy costs $102,600 per QALY (mild fibrosis) or $51,500 per QALY (advanced fibrosis) compared with IL-28B-guided triple therapy and $70,100 per QALY (mild fibrosis) and $36,300 per QALY (advanced fibrosis) compared with standard therapy.
RESULTS OF SENSITIVITY ANALYSIS
Results were sensitive to the cost of protease inhibitors and treatment adherence rates.
LIMITATION
Data on the long-term comparative effectiveness of the new protease inhibitors are lacking.
CONCLUSION
Both universal triple therapy and IL-28B-guided triple therapy are cost-effective when the least-expensive protease inhibitor are used for patients with advanced fibrosis.
PRIMARY FUNDING SOURCE
Stanford University.

Links

Publisher Full Text

Authors

Liu S, Cipriano LE, Holodniy M, Owens DK, Goldhaber-Fiebert JD

Institution

Center for Health Policy, Stanford University, CA, USA.

Source

Annals of internal medicine 156:4 2012 Feb 21 pg 279-90

MeSH

Antiviral Agents
Carcinoma, Hepatocellular
Cost-Benefit Analysis
Decision Support Techniques
Disease Progression
Drug Therapy, Combination
Female
Genotype
Hepatitis C, Chronic
Humans
Interferon-alpha
Interleukins
Liver Cirrhosis
Liver Neoplasms
Male
Markov Chains
Medication Adherence
Protease Inhibitors
Quality-Adjusted Life Years
Ribavirin
Risk Factors
Treatment Outcome

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

22351713