Sofosbuvir-Based Treatment Regimens for Chronic, Genotype 1 Hepatitis C Virus Infection in U.S. Incarcerated Populations

Liu, Shan; Watcha, Daena; Holodniy, Mark; Goldhaber-Fiebert, Jeremy D.

doi:10.7326/m14-0602

Cited by 81 publications

(105 citation statements)

References 53 publications

(78 reference statements)

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“…Cost effectiveness analyses for treatment of hepatitis C have focused on the potential of treatment to prevent development of cirrhosis as well as to prevent the complications of cirrhosis. 39,[47][48][49] The benefit of curing hepatitis C in this regard has been well established. 1,5,10 It is important to recognize that these cost savings are to the system as a whole.…”

Section: Discussionmentioning

confidence: 99%

“…37,38 Recently, a cost-effectiveness study found that treatment of HCV with SOF for genotype 1 patients was cost-effective for certain incarcerated subpopulations but also acknowledged issues of divided benefits and affordability to the correctional system. 39 Thus, long-term cost-effectiveness may still prove to be unfeasible in the context of fixed correctional health budgets. Given the minimal toxicity of these new therapies, correctional health systems may face difficulty rationalizing treatment deferral on medical grounds, creating a potential financial and liability risk.…”

Section: Introductionmentioning

confidence: 99%

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A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

et al. 2015

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Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCVin corrections. The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. Three treatment strategies were evaluated as follows: (1) treating all chronically infected persons, (2) treating only patients with demonstrated fibrosis, and (3) treating only patients with advanced fibrosis. Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. Chronic HCV prevalence was estimated at 17 % of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50 % reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

et al. 2015

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“…Liu és munkatársai fogvatartottaknál vizsgálták a nem kezelés, a peg-IFN+RBV kettős kezelés és ezekhez viszonyítva a boceprevir, illetve sofosbuvir (SOF) hármas kezelés vár-ható kimenetelét, költséghatékonyságát. Számításuk szerint az egyes stratégiák mellett sorrendben 13,12-13,57-14,43-15,18 minőségi életév (QALY) várható, a SOF-kezeléstől várható a dekompezált májcirrhosis (16%) és a hepatocellularis carcinoma (HCC: 9%) előfor-dulásának legnagyobb arányú csökkenése, és ez a kezelés bizonyult legköltséghatékonyabbnak (28 800 USD per QALY) [25]. A DAA hármas kombinációk közül az AbbVie hármas kombináció, illetve Harvoni-kezelés a megfelelő HCV G1/4, illetve G2/3 fertőzött betegeknél az ismert listaárak alapján megtakarítást eredménye-zett a sofosbuvir+simeprevir, illetve sofosbuvir+ribavirin kombinációkhoz képest [26].…”

Section: Táblázatunclassified

A hepatitis C-vírus-fertőzés és kezelésének költségvonzata

Makara

Hunyady

2015

Orvosi Hetilap

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A hepatitis C-vírus-fertőzés a Föld lakosságának 2-3%-át érinti és a betegséghez társuló egyéni következmények mellett igen jelentős össztársadalmi gazdasági problémát jelent. A kiadások elsősorban a nagyszámú fel nem ismert vagy előrehaladott stádiumban felismert betegnél kialakuló májcirrhosis szövődményeihez, a hepaticus encephalopathia, az ascites, a varixvérzés és a hepatocellularis carcinoma ellátásához, valamint a májátültetéshez kapcsolódnak. Nem elhanyagolhatók ugyanakkor a munkában töltött minőségi életévek számának csökkenése miatti veszteségek, valamint a fertőzés kezelésének költségei sem. Utóbbiak az új, interferonmentes terápiák megjelenésével némiképp megemelkedtek a korábbi, proteázgátlóval együtt vagy a nélkül alkalmazott pegilált interferon plusz ribavirin terápiákhoz képest, ugyanakkor komoly megtakarítást jelenthet, hogy lényegesen kevesebb mellékhatással és ehhez kapcsolódó költséggel kell számolni. A témakörben megjelent közlemények szerint a fertőzöttek szűrőprogramokkal történő megtalálása és hatékony készítményekkel történő kezelése rövid távon jelentős többletforrást igényel, de -túl azon, hogy a legtöbbször iatrogén úton okozott betegség meggyógyítása morális társadalmi kötelesség -hosszú távon egyértelműen megtakarítást eredményez. Orv. Hetil., 2015, 156(21), 862-868. Kulcsszavak: antivirális kezelés, direkt ható antivirális szerek, hepatitis C-vírus, interferon, költséghatékonyság Financial burden of hepatitis C infection and its treatmentThe worldwide prevalence of hepatitis C infection is 2-3%. In addition to its individual consequences, it generates huge fi nancial impact on national level. In particular, lack of recognition or late diagnosis of the disease is associated with high rate of liver cirrhosis related complications (hepatic encephalopathy, ascites, variceal bleeding, hepatocellular carcinoma) and/or demands liver transplantation. Loss of quality assisted life years and/or those spent in employment, reduced work productivity, as well as costs of antiviral therapy also contribute to the fi nancial burden. The costs of new interferon-free therapies may exceed the prices of previous pegylated interferon based therapies with or without protease inhibitors; however, shorter treatment durations and extremely low rates of severe side-effects with much less related expenses can reduce total costs of these treatments. In addition to the moral obligations, published cost-effectiveness analyses conclude that early diagnosis and treatment of this primarily iatrogenic infection through organized screening programs and wide access to effective therapies may lead to long term fi nancial benefi t. Rövidítések ABT3D = ombitasvir/paritaprevir/ritonavir+dasabuvir; ASV = asunaprevir; CHC = krónikus C-vírus hepatitis; DCV = daclatasvir; F0-F4 = májfi brosis-stádiumok; G1-G7 = hepatitis C-vírus genotípusok; HCC = hepatocellularis carcinoma; HCV = hepatitis C-vírus; ICER = (incremental cost-effectiveness ratio) növekményi költséghatékonysági arány; IFN = interferon; LDV = ledipasvir; peg-IFN ...

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“…These highly effective treatment regimens improve sustained virologic response rates to well over 90 % among chronically HCV-infected patients, though their price can exceed $50,000 per patient. Despite findings that such treatments offer good value [1][2][3], their high price challenges the affordability of their delivery to all eligible patients. It is estimated that there are more than 3 million free-living people in the USA with chronic HCV infections as well as nearly 1 million incarcerated or institutionalized people with such infections [1,4].…”

mentioning

confidence: 99%

“…Combined with the higher perpatient costs, the total potential expenditures to treat all eligible individuals are now estimated in the hundreds of billions of dollars [1,2]. Who is likely to pay?…”

mentioning

confidence: 99%