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New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis.

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.

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  • 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