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Ann Intern Med. 2012 Feb 21;156(4):279-90. doi: 10.7326/0003-4819-156-4-201202210-00005.

New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis.

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1
Center for Health Policy, Stanford University, CA, USA.

Abstract

BACKGROUND:

Chronic hepatitis C virus is difficult to treat and affects approximately 3 million Americans. Protease inhibitors increase the effectiveness of standard therapy, but they are costly. A genetic assay may identify patients most likely to benefit from this treatment advance.

OBJECTIVE:

To assess the cost-effectiveness of new protease inhibitors and an interleukin (IL)-28B genotyping assay for treating chronic hepatitis C virus.

DESIGN:

Decision-analytic Markov model.

DATA SOURCES:

Published literature and expert opinion.

TARGET POPULATION:

Treatment-naive patients with chronic, genotype 1 hepatitis C virus monoinfection.

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Societal.

INTERVENTION:

Strategies are defined by the use of IL-28B genotyping and type of treatment (standard therapy [pegylated interferon with ribavirin]; triple therapy [standard therapy and a protease inhibitor]). Interleukin-28B-guided triple therapy stratifies patients with CC genotypes to standard therapy and those with non-CC types to triple therapy.

OUTCOME MEASURES:

Discounted costs (in 2010 U.S. dollars) and quality-adjusted life-years (QALYs); incremental cost-effectiveness ratios.

RESULTS OF BASE-CASE ANALYSIS:

For patients with mild and advanced fibrosis, universal triple therapy reduced the lifetime risk for hepatocellular carcinoma by 38% and 28%, respectively, and increased quality-adjusted life expectancy by 3% and 8%, respectively, compared with standard therapy. Gains from IL-28B-guided triple therapy were smaller. If the protease inhibitor costs $1100 per week, universal triple therapy costs $102,600 per QALY (mild fibrosis) or $51,500 per QALY (advanced fibrosis) compared with IL-28B-guided triple therapy and $70,100 per QALY (mild fibrosis) and $36,300 per QALY (advanced fibrosis) compared with standard therapy.

RESULTS OF SENSITIVITY ANALYSIS:

Results were sensitive to the cost of protease inhibitors and treatment adherence rates.

LIMITATION:

Data on the long-term comparative effectiveness of the new protease inhibitors are lacking.

CONCLUSION:

Both universal triple therapy and IL-28B-guided triple therapy are cost-effective when the least-expensive protease inhibitor are used for patients with advanced fibrosis.

PRIMARY FUNDING SOURCE:

Stanford University.

[Indexed for MEDLINE]
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