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New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis.
BACKGROUNDChronic 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.
OBJECTIVETo assess the cost-effectiveness of new protease inhibitors and an interleukin (IL)-28B genotyping assay for treating chronic hepatitis C virus.
DESIGNDecision-analytic Markov model.
DATA SOURCESPublished literature and expert opinion.
TARGET POPULATIONTreatment-naive patients with chronic, genotype 1 hepatitis C virus monoinfection.
INTERVENTIONStrategies 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 MEASURESDiscounted costs (in 2010 U.S. dollars) and quality-adjusted life-years (QALYs); incremental cost-effectiveness ratios.
RESULTS OF BASE-CASE ANALYSISFor 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 ANALYSISResults were sensitive to the cost of protease inhibitors and treatment adherence rates.
LIMITATIONData on the long-term comparative effectiveness of the new protease inhibitors are lacking.
CONCLUSIONBoth 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 SOURCEStanford University.
Center for Health Policy, Stanford University, CA, USA., , ,
Annals of internal medicine 156:4 2012 Feb 21 pg 279-90
Decision Support Techniques
Drug Therapy, Combination
Hepatitis C, Chronic
Quality-Adjusted Life Years
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.