Abstract | OBJECTIVE: DESIGN: This study uses a health economic model to estimate the cost-effectiveness of treating previously untreated and treatment experienced chronic hepatitis C patients who have severe and end stage renal disease with the elbasvir- grazoprevir regimen versus no treatment in the French context. The lifetime homogeneous markovian model comprises of forty combined health states including hepatitis C virus and chronic kidney disease. The model parameters were from a multicentre randomized controlled trial, ANRS CO22 HEPATHER French cohort and literature. 1000 Monte Carlo simulations of patient health states for each treatment strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The results were expressed in cost per quality-adjusted life year (QALY) gained. PATIENTS: The mean age of patients in the HEPATHER French cohort was 59.6 years and 56% of them were men. 22.3% of patients had a F0 fibrosis stage (no fibrosis), 24.1% a F1 stage (portal fibrosis without septa), 7.1% a F2 stage (portal fibrosis with few septa), 21.4% a F3 stage (numerous septa without fibrosis) and 25% a F4 fibrosis stage (compensated cirrhosis). Among these HCV genotype 1 patients, 30% had severe renal impairment stage 4, 33% had a severe renal insufficiency stage 5 and 37% had terminal severe renal impairment stage 5 treated by dialysis. INTERVENTION: RESULTS: EBR/GZR increased the number of life years (6.3 years) compared to no treatment (5.1 years) on a lifetime horizon. The total number of QALYs was higher for the new treatment because of better utility on health conditions (6.2 versus 3.7 QALYs). The incremental cost-utility ratio (ICUR) was of €15,212 per QALY gained for the base case analysis. CONCLUSIONS:
|
Authors | Franck Maunoury, Aurore Clément, Chizoba Nwankwo, Laurie Levy-Bachelot, Armand Abergel, Vincent Di Martino, Eric Thervet, Isabelle Durand-Zaleski |
Journal | PloS one
(PLoS One)
Vol. 13
Issue 3
Pg. e0194329
( 2018)
ISSN: 1932-6203 [Electronic] United States |
PMID | 29543897
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Amides
- Antiviral Agents
- Benzofurans
- Carbamates
- Cyclopropanes
- Imidazoles
- Quinoxalines
- RNA, Viral
- Sulfonamides
- grazoprevir
- elbasvir
|
Topics |
- Amides
- Antiviral Agents
(economics, therapeutic use)
- Benzofurans
(economics, therapeutic use)
- Carbamates
- Cost-Benefit Analysis
(methods)
- Cyclopropanes
- Drug Therapy, Combination
(economics, methods)
- Female
- France
- Genotype
- Hepacivirus
(genetics, isolation & purification)
- Hepatitis C, Chronic
(complications, drug therapy, economics, virology)
- Humans
- Imidazoles
(economics, therapeutic use)
- Kidney Failure, Chronic
(complications, economics, therapy, virology)
- Liver Cirrhosis
(complications, drug therapy, economics, virology)
- Male
- Middle Aged
- Models, Economic
- Quality-Adjusted Life Years
- Quinoxalines
(economics, therapeutic use)
- RNA, Viral
(genetics, isolation & purification)
- Randomized Controlled Trials as Topic
- Renal Dialysis
- Sulfonamides
|