Costs of telaprevir-based triple therapy for hepatitis C: $189,000 per sustained virological response

Abstract

Introduction In registration trials, triple therapy with telaprevir (TVR), pegylated-interferon (IFN), and ribavirin (RBV) achieved sustained virological response (SVR) rates between 64–75%, but the clinical effectiveness and economic burdens of this treatment in real-world practice remain to be determined. Methods Records of 147 patients who initiated TVR-based triple therapy at the Mount Sinai Medical Center (5/2011–12/2011) were reviewed. Direct medical costs for pre-treatment, on-treatment, and post-treatment care were calculated using data from Medicare reimbursement databases, RED Book, and Healthcare Cost and Utilization Project database. Costs are presented in 2012 US dollars. SVR (undetectable HCV RNA 24 weeks after the end-of-treatment) was determined on an intention-to-treat basis. Cost-per-SVR was calculated by dividing the median cost by the SVR rate. Results Median age of the 147 patients was 56 years [interquartile range (IQR) = 51 – 61], 68% were male, 19% were black, 11% had HIV/HCV co-infection, 36% had advanced fibrosis/cirrhosis (FIB-4 scores ≥ 3.25), 44% achieved an SVR. The total cost of care was $11.56 million. Median cost of care was $83,721 per patient (IQR=$66,652– $98,102). The median cost-per-SVR was $189,338 (IQR=$150,735 – $221,860). Total costs were TVR (61%), IFN (24%), RBV (4%), adverse event management (8%), professional fees (2%), and laboratory tests (1%). Conclusions TVR and IFN accounted for 85% of costs. Pharmaceutical prices and the low (44%) SVR rate, in this real-world study, were major contributors to the high cost-per-SVR.

The impact of the new antiviral regimens on patient reported outcomes and health economics of patients with chronic hepatitis C

“…In one study, out of a total of 147 patients who received TVR triple therapy, 44% obtained SVR with a median cost of $188,859 per SVR 24. The unexpected finding was that almost half the costs spent were on patients not obtaining SVR, as well as the cost associated with the management of adverse events and cost associated with the premature discontinuation of treatment [81]. In another study, Sethi et al found that the mean cost of treatment was $172,889 for treatment with a protease inhibitor.…”

“…In one study, costs of obtaining SVR with these regimens ranged from D 66,885 to D 120,350 depending on which triple therapy combination (boceprevir or telaprevir/PEGINF/RBV) was used. These costs were lower for patients who were compliant with treatment [81]. In another study using data from the French national hospital database, investigators determined that the discounted lifetime costs increased with the severity of fibrosis at diagnosis and that treatment with triple therapy increased discounted lifetime costs which were 20% (F2), 28% (F3) and 79% (F4) [79].…”

Personalized Therapy of Chronic Hepatitis C and B Dually Infected Patients With PEGylated Interferon Plus Ribavirin: A Randomized Study

“…Furthermore, in the era of new DAAs, our findings may also provide evidence to obviate unnecessary protease inhibitor 39 or to conduct RGT based on HCV genotype and pretreatment/on-treatment viral kinetics when applying DAA plus Peg-IFN/RBV combination therapy for HBeAg-negative chronic dual HCV/HBV infections. 40 In conclusion, RGT with Peg-IFN plus RBV according to HCV genotype, baseline HCV VL and RVR had comparable efficacy as GGT for HBeAg-negative HBV/HCV dually infected patients. Strategy of RGT with abbreviated regimens may be considered for the clinical settings.…”

Hepatitis C virus: Virology, diagnosis and treatment

“…From 2015, interferonfree anti-HCV regimens with short treatment duration and fewer side effects will be available [84,85,103] . However, peginterferon may still have a role in resource-limited regions due to high cost of DAAs [104] . CHC patients achieved a SVR after anti-HCV treatments exhibited a reduction in all-cause mortality > 50% compared with those who are non-responders [82] .…”

“…The cure rate for HCV infection is expected to be over 95% with the new all-oral, interferon-free regimens within the next few years. However, due to drug resistance [109,110] , suboptimal activity against certain HCV genotypes and the extremely high cost [100,104] , not all patients can be cured. Currently, no effective vaccine is available for HCV infection.…”