Cost–effectiveness analysis of simeprevir with daclatasvir for non-cirrhotic genotype-1b-naïve patients plus chronic hepatitis C

Gimeno‐Ballester, Vicente; Mar, Javier; Miguel, Ramón San

doi:10.1586/14737167.2015.1081061

Cited by 15 publications

(9 citation statements)

References 34 publications

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“…Analyses considering new versus old treatments generally find new treatments to be cost-effective, despite their high costs, for nearly all patient subgroups. Recent studies consider many countries: Canada, 4,5 China, 6,7 Egypt, 8 Germany, 9 Italy, 10,11 Japan, 12–15 Norway, 16 Singapore, 17,18 South Africa, 19 Spain, 20–22 Switzerland, 23 Thailand, 24 the United Kingdom, 25–27 and the United States of America. 28–32 Earlier studies of this type have been summarized in published reviews.…”

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confidence: 99%

Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence

Cipriano

Goldhaber-Fiebert

2018

MDM Policy & Practice

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The World Health Organization HCV Guideline Development Group is considering a “treat all” recommendation for persons infected with hepatitis C virus (HCV). We reviewed the model-based evidence of cost-effectiveness and population health impacts comparing expanded treatment policies to more limited treatment access policies, focusing primarily on evaluations of all-oral directly acting antivirals published after 2012. Searching PubMed, we identified 2,917 unique titles. Sequentially reviewing titles and abstracts identified 226 potentially relevant articles for full-text review. Sixty-nine articles met all inclusion criteria—42 cost-effectiveness analyses and 30 models of population-health impacts, with 3 articles presenting both types of analysis. Cost-effectiveness studies for many countries concluded that expanding treatment to people with mild liver fibrosis, who inject drugs (PWID), or who are incarcerated is generally cost-effective compared to more restrictive treatment access policies at country-specific prices. For certain patient subpopulations in some countries—for example, elderly individuals without fibrosis—treatment is only cost-effective at lower prices. A frequent limitation is the omission of benefits and consequences of HCV transmission (i.e., treatment as prevention; risks of reinfection), which may underestimate or overestimate the cost-effectiveness of a “treat all” policy. Epidemiologic modeling studies project that through a combination of prevention, aggressive screening and diagnosis, and prompt treatment for all fibrosis stages, it may be possible to virtually eliminate HCV in many countries. Studies show that if resources are not available to diagnose and treat all HCV-infected individuals, treatment prioritization may be needed, with alternative prioritization strategies resulting in tradeoffs between reducing mortality or reducing incidence. Notably, because most new HCV infections are among PWID in many settings, HCV elimination requires unrestricted treatment access combined with injection transmission disruption strategies. The model-based evidence suggests that a properly constructed strategy that substantially expands HCV treatment could achieve cost-effective improvements in population health in many countries.

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confidence: 99%

Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence

Cipriano

Goldhaber-Fiebert

2018

MDM Policy & Practice

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“…The cycle lengths were estimated using the data reported in each publication. A not applicable (NA) was added for studies without cycle length Sources: Intervention models included in analysis: Cure 2015a [ 28 ], Cure 2015b [ 29 ], Linas, 2015 [ 37 ], Liu 2014 [ 39 ], Najafzadeh 2015 [ 41 ], San Miguel 2015 [ 47 ], Saab 2014 [ 46 ]; Intervention models excluded from analysis: Athanasakis 2015 [ 17 ], Blazques-Perez 2013 [ 18 ], Brogan 2014 [ 19 ], Camma 2012 [ 21 ], Camma 2013 [ 20 ], Chan 2013 [ 22 ], Chhatwal 2013 [ 23 ], Chhatwal 2015 [ 24 ], Cortesi 2015 [ 25 ], Cure 2014a [ 26 ], Cure 2014b [ 27 ], Dan 2015 [ 30 ], Elbasha 2013 [ 31 ], Ferrante 2013 [ 32 ], Gimeno-Ballester 2016 [ 33 ], Hagan 2014 [ 34 ], Leleu, 2015 [ 35 ]; Linas 2014 [ 36 ], Liu 2012 [ 38 ], McEwan 2014 [ 40 ], Petta 2014a [ 43 ], Petta 2014b [ 42 ], Rein 2015 [ 45 ], Tice 2015 [ 48 ], Vellopoulou 2014 [ 49 ], Warren 2014 [ 50 ], Westerhout 2015 [ 51 ], Younossi 2015 [ 52 ], Zhang 2015 [ 53 ]…”

Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of diagnostic and therapeutic interventions for chronic hepatitis C: a systematic review of model-based analyses

Castro

Crathorne

Perazzo

et al. 2018

BMC Med Res Methodol

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BackgroundDecisions about which subgroup of chronic hepatitis C (CHC) patients should be treated with direct acting anti-viral agents (DAAs) have economic importance due to high drug prices. Treat-all DAA strategies for CHC have gained acceptance despite high drug acquisition costs. However, there are also costs associated with the surveillance of CHC to determine a subgroup of patients with significant impairment. The aim of this systematic review was to describe the modelling methods used and summarise results in cost-effectiveness analyses (CEAs) of both CHC treatment with DAAs and surveillance of liver disease.MethodsElectronic databases including Embase and Medline were searched from inception to May 2015. Eligible studies included models predicting costs and/or outcomes for interventions, surveillance, or management of people with CHC. Narrative and quantitative synthesis were conducted. Quality appraisal was conducted using validated checklists. The review was conducted following principles published by NHS Centre for Research and Dissemination.ResultsForty-one CEAs met the eligibility criteria for the review; 37 evaluated an intervention and four evaluated surveillance strategies for targeting DAA treatment to those likely to gain most benefit. Included studies were of variable quality mostly due to reporting omissions. Of the 37 CEAs, eight models that enabled comparative analysis were fully appraised and synthesized. These models provided non-unique cost-effectiveness estimates in a specific DAA comparison in a specific population defined in terms of genotype, prior treatment status, and presence or absence of cirrhosis. Marked heterogeneity in cost-effectiveness estimates was observed despite this stratification. Approximately half of the estimates suggested that DAAs were cost-effective considering a threshold of US$30,000 and 73% with threshold of US$50,000. Two models evaluating surveillance strategies suggested that treating all CHC patients regardless of the staging of liver disease could be cost-effective.ConclusionsCEAs of CHC treatments need to better account for variability in their estimates. This analysis suggested that there are still circumstances where DAAs are not cost-effective. Surveillance in place of a treat-all strategy may still need to be considered as an option for deploying DAAs, particularly where acquisition cost is at the limit of affordability for a given health system.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0515-9) contains supplementary material, which is available to authorized users.

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“…Hence, drug listing and subsidization are important factors impacting potential accessibility and uptake. Cost-effectiveness studies of DAA-based treatments have been conducted broadly in Europe, USA, Australia, and Asian countries, with the majority estimating the ICERs of new e.Proofing http://eproofing.springer.com/journals/printpage.php?token=Y4M34JH... treatments to be within the accepted range of medical practices and willingnessto-pay [5,11,12,13,14,15,16,17,18,30,31,32]. However, there are derived assumptions on population profile, disease progression, and economic factors across various models, which limited their generalizability.…”

Section: Figmentioning

confidence: 99%

“…Unlike traditional CEA studies using quality-adjusted life years as the long-term measurement of health outcomes [11,12,18,30,31,32], a simplified decision analytic model was used to assess the cost-effectiveness of different treatments during the treatment course (12-48 weeks) to provide timely costs data relevant to stakeholders, including clinicians, patients, and policymakers. This study indicated that the medication cost of DAA-based treatments was more than twice that of the INF-based treatment; however, the total cost per treatment success was partially paid off by the greatly shortened treatment duration and improved rate of SVR.…”

Section: Figmentioning

confidence: 99%

Budget impact and cost-effectiveness analyses of direct-acting antivirals for chronic hepatitis C virus infection in Hong Kong

Chan

Tam

et al. 2017

Eur J Clin Microbiol Infect Dis

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The purpose of this investigation was to evaluate the budget impact and cost-effectiveness of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection in Hong Kong. A decision analytic model was developed to compare short-term costs and health outcomes of patients with chronic HCV genotype 1 infection in Hong Kong who were treated with an interferon (INF)-based treatment (dual therapy of pegylated interferon and ribavirin) or DAA-based treatments (sofosbuvir or ledipasvir/sofosbuvir or ombitasvir/paritaprevir/ritonavir plus dasabuvir). Compared to INF-based treatment, DAA-based treatments yielded an incremental cost of $24,677-$31,171 per course while improving the rate of sustained virologic response (SVR) from 59-66% to 82.3-99.8%. The incremental cost-effective ratios of DAA-based treatments ranged from $9724 to $29,189 per treatment success, which were all below the cost-effectiveness threshold of local GDP per capita ($42,423 in 2015). Introducing DAAs resulted in a 126.1% ($383.7 million) budget increase on HCV infection management over 5 years. A 50% change in DAA medication costs reflected a change in the incremental budget from $55.2 to $712.3 million. DAA-based treatments are cost-effective alternatives to INF-based treatment in Hong Kong. Introducing DAAs to the public hospital formulary yields a considerable budget increase but is still economically favorable to the local government.

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Cost–effectiveness analysis of simeprevir with daclatasvir for non-cirrhotic genotype-1b-naïve patients plus chronic hepatitis C

Abstract: SMV/DCV combination compared with the standard of care previous to the arrival of second-generation direct-acting antivirals fell below generally accepted willingness-to-pay threshold. Results obtained should be supported by ongoing clinical trials.

Cited by 15 publications

References 34 publications

Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence

Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence

Cost-effectiveness of diagnostic and therapeutic interventions for chronic hepatitis C: a systematic review of model-based analyses

Budget impact and cost-effectiveness analyses of direct-acting antivirals for chronic hepatitis C virus infection in Hong Kong

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