Treatment Patterns, Health Care Resource Utilization, and Costs in U.S. Patients Diagnosed with Chronic Hepatitis C Infection Who Received Telaprevir or Boceprevir

Le, Trong Kim; Kalsekar, Anupama; Macaulay, Dendy; Yuan, Yong; Sorg, Rachael; Behrer, Christopher; Wei, Jin; Wu, Eric Q.

doi:10.18553/jmcp.2015.21.4.308

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…Regarding the results of our chart review, numerous studies in other countries have demonstrated similar findings, with antiviral drugs accounting for the majority of treatment costs 13,15,27–29. However, they estimate that antiviral costs would amount to around 75–85% of total costs, which is lower than our calculation of 92%.…”

Section: Discussionsupporting

confidence: 79%

The cost of successful antiviral therapy in hepatitis C patients: a comparison of IFN-free versus IFN-based regimens at an individual patient level in Australia

Lee¹,

Driel²,

Crawford³

2017

CEOR

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BackgroundChronic hepatitis C remains a major global health burden with serious long-term consequences if left untreated. Recently the treatment standard of care has shifted to new interferon (IFN)-free drug regimens, which have been shown to be safe and effective. The aim of our study was to assess and compare medical resource utilization and costs of successfully treating patients with IFN-based and IFN-free therapies in Australia.MethodsWe performed a retrospective chart review of 30 HCV-infected patients successfully treated with IFN-based therapy between 2013 and 2015. We also generated a model for a virtual group of 100 genotype 1 (GT1) and 100 genotype 3 (GT3) patients treated with IFN-free therapy derived from national guidelines and clinical trial data.ResultsIn comparison to virtual patients receiving IFN-free therapy, our IFN-treated patients on average had distinctively more liver clinic visits and blood tests. However, mean total cost per patient was $19,164 and $85,300 (AUD) more for GT1 and GT3 patients receiving IFN-free therapy, respectively. This difference was largely accounted for by higher antiviral drug costs. Of our 30 patients treated with IFN, total mean cost per patient during the study period was $33,595.ConclusionResource utilization is lower with IFN-free treatment, which reflects the reduced need for patient monitoring and improved side-effect profile of these new drugs. However, total costs are still largely dominated by antiviral drug costs, representing a huge burden on national budgets. Our insight into resource utilization and costs associated with both types of treatment can serve as a reference for future studies.

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Section: Discussionsupporting

confidence: 79%

The cost of successful antiviral therapy in hepatitis C patients: a comparison of IFN-free versus IFN-based regimens at an individual patient level in Australia

Lee¹,

Driel²,

Crawford³

2017

CEOR

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“…This may have resulted in larger denominators for the PDC calculation and underestimated the adherence rates. In contrast to the protease inhibitor-based regimens, 24 the high adherence to SOF-based regimens may be attributable to their greater tolerability.…”

Section: Discussionmentioning

confidence: 99%

Sofosbuvir-Based Regimens for Chronic Hepatitis C in a Well-Insured U.S. Population: Patient Characteristics, Treatment Adherence, Effectiveness, and Health Care Costs, 2013-2015

Yin

Barker

White

et al. 2019

JMCP

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BACKGROUND: Chronic hepatitis C (CHC) is a leading cause of morbidity and mortality and has imposed a high health care burden in the United States. Direct-acting antiviral (DAA) regimens are well tolerated and highly effective for CHC therapy but were initially marketed at a high price. Studies of their real-world use with a nationwide population are limited. OBJECTIVE: To examine patient characteristics, treatment adherence, effectiveness, and health care costs in a large U.S. population with commercial and Medicare supplemental insurance plans who received simeprevir (SIM), sofosbuvir (SOF), or ledipasvir/sofosbuvir (LED/SOF) during the years 2013–2015. METHODS: Patients with at least 1 diagnosis code for CHC and at least 1 claim for SIM, SOF, or LED/SOF prescriptions were selected. The date of the first claim for SIM, SOF, or LED/SOF was defined as the index date. Analyses were stratified by 4 regimens: SOF + SIM ± ribavirin (RBV), SOF + peginterferon alpha-2a or 2b (PEG) + RBV, SOF + RBV, and LED/SOF ± RBV. Adherence was defined by the proportion of days covered (PDC) ≥ 80%. Sustained virologic response (SVR12) was defined as a hepatitis C virus (HCV) RNA load of ≤ 25 IU/mL measured at ≥ 12 weeks following the end of the days supply of the last DAA refill. Health care costs such as DAA drug costs and medical costs (inpatient costs plus outpatient costs) were described. RESULTS: Of 10,808 CHC patients, approximately two thirds were male, and mean age was 55 years. The proportion of patients with compensated cirrhosis among each regimen ranged from 7.4% in LED/SOF ± RBV to 13.8% in SOF + SIM ± RBV, and the proportion of patients with decompensated cirrhosis ranged from 3.9% in LED/SOF ± RBV to 10.7% in SOF + SIM ± RBV. The majority of patients (89.0%) used the newer regimen LED/SOF ± RBV in 2015. Adherence rates were estimated at 80.5%, 81.5%, 85.7%, and 91.4% for SOF + SIM ± RBV (n = 1,761); SOF + PEG + RBV (n = 1,314); SOF + RBV (n = 1,994); and LED/SOF ± RBV (n = 5,739), respectively. Regimen-specific adherence predictors included sex, age group, payer type, health plan, and treatment option with RBV. Being born during 1945–1965, liver disease severity, and Charlson Comorbidity Index levels did not predict adherence in any regimen. Overall SVR12 was 92.6% in 203 patients with available HCV RNA results: 100% (41/41) in SOF + SIM ± RBV; 83.3% (25/30) in SOF + PEG + RBV; 90.6% (29/32) in SOF + RBV; and 93% (93/100) in LED/SOF ± RBV. While the drug costs for these DAA regimens were initially high, they had decreased 18.9% (P < 0.001) during 2013–2015. Medical costs decreased 9.2% (P < 0.001) 1 year after the index dates. CONCLUSIONS: These results indicate that DAA drug costs decreased steadily during 2013–2015 and that 89% of patients on SOF-based DAA regimens took newer, lower-cost regimens with adherence rates above 80%. Available data show that SVR12 rates were close to those obtained in clinical studies. Medical costs also significantly decreased 1 year after the index dates.

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“…Patients by Adherence Level (adherent) were noted in 60% of patients receiving PEG-IFN with RBV, 46% on PEG-IFN alone, and only 36% of patients taking nonpegylated IFN plus RBV in 1 study; another analysis reported incomplete therapy rates of 74% for BOC and 54% for TVR. 28,37 Several factors may explain these differences, including differing definitions and calculations for adherence, varied follow-up periods, and greater clinical oversight associated with prospective studies and the Veterans Affairs health care program. Treatment discontinuation rates for newer DAAs appear to be much lower (1%-2%) than older therapies, possibly because of better tolerability and oral dosing.…”

Section: Risk Of Liver Transplant In Treatedmentioning

confidence: 99%

Does Hepatitis C Treatment Adherence Affect Risk of Liver Transplantation? A Historical Cohort Study

Ems

Racsa

Anderson

et al. 2016

JMCP

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No outside funding supported this research. Ems, Worley, Racsa, Gregory, Anderson, and Holt are employees of Humana. Brill has participated in a physician advisory board at Humana. The authors have no other financial disclosures to report. Study concept and design were contributed by Ems, Racsa, Worley, and Anderson, along with Gregory, Brill, and Holt. Racsa took the lead in data collection, along with Ems and Worley. All authors participated in data interpretation. Anderson, along with the other authors, wrote the manuscript, which was revised by Brill and Holt, with assistance from the other authors.

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Treatment Patterns, Health Care Resource Utilization, and Costs in U.S. Patients Diagnosed with Chronic Hepatitis C Infection Who Received Telaprevir or Boceprevir

Cited by 6 publications

References 21 publications

The cost of successful antiviral therapy in hepatitis C patients: a comparison of IFN-free versus IFN-based regimens at an individual patient level in Australia

The cost of successful antiviral therapy in hepatitis C patients: a comparison of IFN-free versus IFN-based regimens at an individual patient level in Australia

Sofosbuvir-Based Regimens for Chronic Hepatitis C in a Well-Insured U.S. Population: Patient Characteristics, Treatment Adherence, Effectiveness, and Health Care Costs, 2013-2015

Does Hepatitis C Treatment Adherence Affect Risk of Liver Transplantation? A Historical Cohort Study

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