Cost-effectiveness analysis of treatment with peginterferon-alfa-2a versus peginterferon-alfa-2b for patients with chronic hepatitis C under the public payer perspective in Brazil

Abstract

BackgroundChronic hepatitis C affects approximately 170 million people worldwide, and thus being one of the main causes of chronic liver disease. About 20% of patients with chronic hepatitis C will develop cirrhosis over 20 years, and present an increased risk of developing hepatic complications. Sustained virological response (SVR) is associated with a better prognosis compared to untreated patients and treatment failures.The objective of this analysis was to compare treatment costs and outcomes of pegylated interferon-alfa-2a versus pegylated interferon-alfa-2b, both associated with ribavirin, in the therapeutic scheme of 24 weeks and 48 week for hepatitis C genotypes 2/3 and genotype 1, respectively, under the Brazilian Public Health System (SUS) scenario.MethodsTo project disease progression, a Markov model was built based on clinical stages of chronic disease. A Delphi panel was conducted to evaluate medical resources related to each stage, followed by costing of related materials, services, procedures and pharmaceutical products. The evaluation was made from a public payer perspective. The source used for costing was government reimbursement procedures list (SAI/SIH–SUS). Drug acquisition costs were obtained from the Brazilian Official Gazette and “Banco de Preços em Saúde” (government official source). It was assumed a mean patient weight of 70 kg. Costs were reported in 2011 Brazilian Reais (US$1 ≈ $Brz1.80). A systematic review followed by a meta-analysis of the 7 identified randomized controlled trials (RCTs) which compared pegylated interferons, was conducted for obtaining relative efficacy of both drugs: for genotype 2/3, mean rate of SVR was 79.2% for peginterferon-alfa-2a and 73.8% for peginterferon-alfa-2b. For genotype 1, SVR mean rate was 42.09% versus 33.44% (peginterferon-alfa-2a and peginterferon-alfa-2b respectively). Time horizon considered was lifetime. Discount rate for costs and outcomes was 5%, according to Brazilian guidelines for Health Technology Assessment (HTA).ResultsAnalysis showed that peginterferon-alfa-2a is a dominant therapy compared to peginterferon-alfa-2b for genotype 1 ($Brz 4,345 savings and 0.10 LY/0.25 QALY gains) as well for genotype 2/3 ($Brz 8,001 savings and 0.16 LY/0.39 QALY gains). Projections indicated that for each 1000 patients treated with peginterferon-alfa-2a instead of peginterferon-alfa-2b, the amount of resources saved would be of $Brz 4.3 million for genotypes 2/3 and up to $Brz 8 million for genotype 1.ConclusionThese findings suggest that treatment with peginterferon-alfa-2a is more effective and less costly when compared to peginterferon-alfa-2b under SUS perspective in Brazil.

Real-World Data for the Evaluation of Transarterial Radioembolization versus Sorafenib in Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

“…For each health state considered in the model (stable disease, progression, and liver transplantation) excluding death, utility coefficients were retrieved and an average value was derived. A summary of the retrieved utilities and related mean values is presented in Appendix Table 1 [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] …”

IFN-λ gene polymorphisms as predictive factors in chronic hepatitis C treatment-naive patients without access to protease inhibitors

“…The current treatment for chronic hepatitis C in Brazil and in the world still demand a large investment in medical and economic resources and may impact the quality of life of patients due to adverse events resulting from treatment, particularly those based on interferon [Fonseca et al, ; Barros et al, ; Backx et al, ]. Several efforts are underway to ensure that new treatments are available, such as the second generation (second‐wave) of direct‐acting antivirals sofosbuvir, simeprevir, and faldaprevir.…”

“…The introduction of new treatment regimens, such as first‐wave of two direct‐acting antivirals (DAAs) in the antiviral triple therapy with the proteases inhibitors (PI), boceprevir (BOC), and telaprevir (TVR), have increased the SVR ratio for patients infected with genotype 1. However, there are patients who experience adverse events and do not have any clinical benefit during treatment [Campiotto et al, ; Fonseca et al, ; Barros et al, ; Hajarizadeh et al, ]. Moreover, antiviral triple therapy with the second‐wave of DAAs such as simeprevir [Jacobson et al, ; Manns et al, ], sofosbuvir [Gentile et al, ], and faldaprevir [Sulkowski et al, ,; Asselah and Marcellin, ] have provided for this patients and their doctors more treatment options but still not a reality in the health public system of Brazil.…”

“…Patients infected with genotype 1 are the majority of cases in Brazil, which leads to high costs to government without corresponding effectiveness. Therefore, it is necessary to evaluate the best clinical evidence for factors associated with the prediction of therapeutic response, to support the potential incorporation of the assessment these factors during the diagnostic process in patients [Barros et al, ].…”

Chronic Hepatitis C: An Overview of Evidence on Epidemiology and Management from a Brazilian Perspective

“…CHC was associated with depression [ 68 ] and sexual dysfunction [ 69 ] and the diagnosis of HCV was frequently considered a traumatic experience [ 70 ]. Few studies used quality-adjusted life years (QALY) as an outcome measure to estimate effects of interventions for Brazilian patients [ 71 , 72 ]. However, both studies have used international data for utilities estimation due to local information unavailability.…”