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

Abstract

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.

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

“…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). …”

Cost-Utility Analyses of Cognitive-Behavioural Therapy of Depression: A Systematic Review

“…There are different rules of thumb to classify incremental cost per QALY ratios. We employed a widely used [15,16,17,18] threshold of 50,000 USD PPP per QALY or DALY to distinguish cost-effective from economically unfavourable interventions. If the test intervention is less costly and more effective than the control intervention, the test intervention is called ‘dominant'.…”

Boceprevir for Chronic Genotype 1 Hepatitis C Virus in the Current Health Care Setting in Greece: A Cost-effectiveness Analysis

“…In a similar study of the cost-effectiveness of boceprevir in previously treated individuals, boceprevir was also found to be cost-effective. 36 Blázquez-Pérez et al 37 investigated the costeffectiveness of combination therapy with a newly developed protease inhibitor (boceprevir or telaprevir) plus PEG þ RBV versus SOC in treatment-naive patients with G1 HCV according to data obtained from clinical trials. The data showed that both protease inhibitors appeared cost-effective compared with SOC, with boceprevir producing slightly more favorable ICER and QALY values in treatment-naïve individuals.…”