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Clin Gastroenterol Hepatol. 2013 Nov;11(11):1503-10. doi: 10.1016/j.cgh.2013.05.014. Epub 2013 May 22.

Cost effectiveness of direct-acting antiviral therapy for treatment-naive patients with chronic HCV genotype 1 infection in the veterans health administration.

Author information

1
Department of Health Sciences, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, Massachusetts; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts; VA HIV/Hepatitis Quality Enhancement Research Initiative, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.

Abstract

BACKGROUND & AIMS:

The Veterans Health Administration (VHA) is the largest single provider of care for hepatitis C virus (HCV) infection in the United States. We analyzed the cost effectiveness of treatment with the HCV protease inhibitors boceprevir and telaprevir in a defined managed care population of 102,851 patients with untreated chronic genotype 1 infection.

METHODS:

We used a decision-analytic Markov model to examine 4 strategies: standard dual-therapy with pegylated interferon-alfa and ribavirin (PR), the combination of boceprevir and PR triple therapy, the combination of telaprevir and PR, or no antiviral treatment. A sensitivity analysis was performed. Sources of data included published rates of disease progression, the census bureau, and VHA pharmacy and hospitalization cost databases.

RESULTS:

The estimated costs for treating each patient were $8000 for PR, $31,300 for boceprevir and PR, and $41,700 for telaprevir and PR. Assuming VHA treatment rates of 22% and optimal rates of sustained virologic response, PR, boceprevir and PR, and telaprevir and PR would reduce relative liver-related deaths by 5.2%, 10.9%, and 11.5%, respectively. Increasing treatment rates to 50% would reduce liver-related deaths by 12%, 24.7%, and 26.1%, respectively. The incremental cost-effectiveness ratios were $29,184/quality-adjusted life-years for boceprevir and PR and $44,247/quality-adjusted life-years for telaprevir and PR vs only PR. With the current 22% treatment rate, total system-wide costs to adopt boceprevir and PR or telaprevir and PR would range from $708 to $943 million.

CONCLUSIONS:

Despite substantial up-front costs of treating HCV-infected patients in the VHA with PR, or telaprevir and PR, each regimen improves quality of life and extends life expectancy by reducing liver-related morbidity and mortality, and should be cost effective. Further efforts to expand access to direct-acting antiviral therapy are warranted.

KEYWORDS:

Cirrhosis; DAA; HCC; HCV; Health Care Costs; ICER; IL; Liver Disease; PR; Prevention; QALY; SVR; VHA; Veterans Health Administration; boc; boceprevir; direct-acting antiviral; hepatitis C virus; hepatocellular carcinoma; incremental cost-effectiveness ratio; interleukin; pegylated interferon-alfa and ribavirin; quality-adjusted life-year; sustained virologic response; tel; telaprevir

PMID:
23707354
DOI:
10.1016/j.cgh.2013.05.014
[Indexed for MEDLINE]
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