Cost-Effectiveness of <b><i>IL28&#x0392;</i></b> Genotype-Guided Protease Inhibitor Triple Therapy versus Standard of Care Treatment in Patients with Hepatitis C Genotypes 2 or 3 Infection

Abstract

Background/Aims: Triple therapy [adding protease inhibitors to standard of care (SOC)] dramatically increases treatment response in selected patients with hepatitis C virus (HCV). Interleukin 28B (IL28Β) genotyping helps predict responsiveness in these patients; however, the economic implications of IL28Β genotyping in HCV genotype 2 or 3 infected patients are unknown. Short- and long-term costs and outcomes of SOC therapy were calculated and used to determine the cost-effectiveness thresholds for using triple therapy in HCV genotype 2 or 3 infected patients. Methods: Costs and outcomes were calculated by conducting cohort simulations on decision trees modeling SOC and triple therapy. Quality-adjusted life expectancies and long-term costs were predicted through Markov modeling. Results: For triple therapy to be cost-effective, sustained virologic response (SVR) rates must improve (depending on age) by 7.91-11.11 and 9.06-12.8% for HCV genotype 2 and 3 cohorts, respectively. When triple therapy is guided by 2 IL28Β variants, a 2.63-3.72% improvement in SVR is needed for cost-effectiveness, and when guided by only one variant, a 1.4-8.91% improvement is needed. Conclusions: Markov modeling revealed that modest increases in SVR rates from IL28Β-guided triple therapy can lead to both lower costs and better health outcomes than SOC therapy in the long run.

Hospital nursing leadership-led interventions increased genomic awareness and educational intent in Magnet settings

“…The primary aim of genomic clinical applications is improved health outcomes (3). Evidence of potential cost savings associated with the appropriate use of genomic information and technology is emerging, a priority in the current fiscal climate (4–7). Advances having significant ethical and safety challenges motivate nursing schools to integrate genomic content into curricula.…”

Research Directions in the Clinical Implementation of Pharmacogenomics: An Overview of US Programs and Projects

“…In addition to prospective data collection, cost-effectiveness can be estimated using economic modeling. An example from Geisinger Health System examined the use of IL28B genotyping to inform the use of triple therapy for Hepatitis C viral genotypes 2 and 3 (12). Threshold analysis predicted a high likelihood of cost-effectiveness if IL28B genotyping results were routinely used; this was subsequently implemented clinically.…”