Boceprevir for previously untreated patients with chronic hepatitis C Genotype 1 infection: a US-based cost-effectiveness modeling study

Ferrante, Shannon; Chhatwal, Jagpreet; Brass, Clifford A.; Khoury, Antoine C. El; Poordad, Fred; Bronowicki, Jean Pierre; Elbasha, Elamin H.

doi:10.1186/1471-2334-13-190

Cited by 47 publications

(33 citation statements)

References 55 publications

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“…What’s more, between-model consistency was also assessed by comparing some features of our model with those of existing models and by comparing results simulated from our model with those of Ferrante et al [42]. After the simulation, validating to lifetime costs and QALYs produced R 2 statistics of 0.979, 0.997, respectively (S1 Fig).…”

Section: Methodsmentioning

confidence: 90%

Estimating cost-effectiveness associated with all-oral regimen for chronic hepatitis C in China

Chen¹,

Chen²

2017

PLoS ONE

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BackgroundAll-oral regimens are associated with higher effectiveness and shorter treatment duration for chronic hepatitis C. Given its superior effect and enormous patients in China, clinicians or patients may be compelled to consider delaying treatment for all-oral regimen.ObjectiveTo estimate cost-effectiveness of delaying treatment for all-oral regimen in the subsequent years under different assumptions about their price and efficacy compared with standard of care in China.MethodsA state-transition Markov model was developed to estimate lifetime costs and quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio (ICER) and net monetary benefit (NB) were calculated. And sensitivity analyses were also performed to assess the impact of uncertainty.ResultsFor treatment naive patients with Genotype 1, immediate treatment with all-oral regimen under assumed cost and efficacy at present was cost-effective compared with peginterferon α-2a (PegIFN) regimen at present with an ICER of $12536 per QALY gained and a positive NB of $6832 at a willingness-to-pay threshold of $21209. And it was more than 95% likely to be cost-effective if weekly drug cost was less than $1000. Moreover, patients delaying treatment for all-oral regimen in the 1st year were associated with increase in QALYs of 0.62 and increase in cost of $10114 compared with initiating PegIFN regimen at present, which resulted in a positive NB of $3115.ConclusionFrom a payer perspective, all-oral regimen is associated with good long-term health and economic benefit for treatment-naive patients infected with HCV genotype 1. Particularly, if all-oral regimen would become available at lower price in the future, delaying treatment for all-oral regimen may be a good choice for patients in China.

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Section: Methodsmentioning

confidence: 90%

Estimating cost-effectiveness associated with all-oral regimen for chronic hepatitis C in China

Chen¹,

Chen²

2017

PLoS ONE

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“…To our knowledge, no previous study has evaluated the cost-effectiveness of treatment with PIs in patients who failed prior treatment in the US. Several studies have evaluated the cost-effectiveness of PIs in treatment naïve patients [13,47,48]. We also made several updates in the model structure and inputs, in comparison with previously published models on hepatitis C. First, our model included two components — treatment phase and natural history phase, and included early discontinuations and management of anemia.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Boceprevir in Patients Previously Treated for Chronic Hepatitis C Genotype 1 Infection in the United States

et al. 2013

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Objectives The phase 3 trial, RESPOND-2, demonstrated that the addition of boceprevir (BOC) to peginterferon-ribavirin (PR) resulted in significantly higher rates of sustained virologic response (SVR) in previously treated patients with chronic hepatitis C virus (HCV) genotype-1 infection as compared with PR alone. We evaluated the cost-effectiveness of treatment with boceprevir in previously treated chronic hepatitis C patients in the United States utilizing treatment related data from RESPOND-2 and PROVIDE. Methods We developed a Markov cohort model to project the burden of HCV disease, lifetime costs and quality-adjusted life years (QALY) associated with PR and two BOC-based therapies—response-guided therapy (BOC/RGT) and fixed-duration therapy for 48 weeks (BOC/PR48). We estimated treatment related inputs (efficacy, adverse events, and discontinuations) from clinical trials and obtained disease progression rates, costs and quality-of-life data from published studies. We estimated the incremental cost-effectiveness ratio (ICER) for BOC-based regimens as studied in RESPOND-2, as well as by patient’s prior response to treatment and IL-28B genotype. Results Boceprevir-based regimens were projected to reduce the lifetime incidence of liver-related complications by 43–53% in comparison with treatment with PR. The ICER of BOC/RGT in comparison with PR was $30,200, and the ICER of BOC/PR48 in comparison with BOC/RGT was $91,500. At $50,000 willingness-to-pay, the probabilities BOC/RGT and BOC/PR48 being the preferred option were 0.74 and 0.25, respectively. Conclusions In patients previously treated for chronic HCV genotype-1 infection, boceprevir was projected to increase QALYs and reduce the lifetime incidence of liver complications. In addition, boceprevir-based therapies were projected to be cost-effective in comparison with PR alone at commonly used willingness-to-pay thresholds.

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“…We used a weekly cycle length to advance time in the model. The structure of the model was based on our previously published and validated Markov cohort model (22, 23). …”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness and Budget Impact of Hepatitis C Virus Treatment With Sofosbuvir and Ledipasvir in the United States

et al. 2015

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Background The recently approved drugs, sofosbuvir and ledipasvir, for chronic hepatitis C virus (HCV) treatment are more efficacious and safer but are substantially more expensive than the old standard-of-care (oSOC). It remains unclear whether and in which patients their improved efficacy justifies their increased cost. Objective To evaluate the cost-effectiveness and budget impact of sofosbuvir- and ledipasvir-based therapies. Design Simulation model of the natural history of HCV. Data Sources Published literature. Target population Treatment-naive and treatment-experienced HCV population defined on the basis of HCV genotype, age and fibrosis distribution in the United States. Time Horizon Lifetime. Perspective Third-party payer. Interventions Simulation of sofosbuvir/ledipasvir-based therapies compared with the oSOC that consisted of interferon-based therapies. Outcomes Measures Quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and 5-year spending on antiviral drugs. Results of Base-Case Analysis Sofosbuvir-based therapies added 0.56 QALY relative to the oSOC, at an incremental cost of $55 400 per additional QALY. The ICERs ranged from $9700 to $284 300 per QALY depending on the patient’s status with respect to prior treatment, HCV genotype, and the presence of cirrhosis. At $100 000 willingness-to-pay per QALY, sofosbuivr-based therapies were cost-effective in 83% of treatment-naive and 81% of treatment-experienced patients. Compared with the oSOC, new drugs would cost an additional $65 billion in the next 5 years to treat eligible HCV-infected people in the United States, whereas the resulting cost offsets would be $16 billion. Results of Sensitivity Analysis Results were sensitive to the drug price, drug efficacy and quality-of-life after a successful treatment. Limitation Data on real world effectiveness of new antivirals is lacking. Conclusions HCV treatment is cost-effective in the majority of patients, but additional resource and value-based patient prioritization are needed to manage HCV patients.

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Boceprevir for previously untreated patients with chronic hepatitis C Genotype 1 infection: a US-based cost-effectiveness modeling study

Cited by 47 publications

References 55 publications

Estimating cost-effectiveness associated with all-oral regimen for chronic hepatitis C in China

Estimating cost-effectiveness associated with all-oral regimen for chronic hepatitis C in China

Cost-Effectiveness of Boceprevir in Patients Previously Treated for Chronic Hepatitis C Genotype 1 Infection in the United States

Cost-Effectiveness and Budget Impact of Hepatitis C Virus Treatment With Sofosbuvir and Ledipasvir in the United States

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