A Cost-Effectiveness Analysis of Shortened Direct-Acting Antiviral Treatment in Genotype 1 Noncirrhotic Treatment-Naive Patients With Chronic Hepatitis C Virus.

Abstract

BACKGROUND:

Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs.

OBJECTIVES:

To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients.

METHODS:

Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies.

RESULTS:

The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course.

CONCLUSIONS:

Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective.

• Authors: Christopher G Fawsitt, Peter Vickerman, Graham Cooke, Nicky J Welton, STOP-HCV Consortium
• Journal: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research (Value Health) Vol. 22 Issue 6 Pg. 693-703 (06 2019) ISSN: 1524-4733 [Electronic] United States
• PMID: 31198187 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.

Chemical References

• Aminoisobutyric Acids
• Antiviral Agents
• Carbamates
• Cyclopropanes
• Heterocyclic Compounds, 4 or More Rings
• Lactams, Macrocyclic
• Macrocyclic Compounds
• Quinoxalines
• Sulfonamides
• voxilaprevir
• Proline
• Leucine
• velpatasvir
• Sofosbuvir

Topics

• Aminoisobutyric Acids
• Antiviral Agents (economics, therapeutic use)
• Carbamates (economics, therapeutic use)
• Cost-Benefit Analysis
• Cyclopropanes
• Decision Trees
• Hepacivirus (drug effects, pathogenicity)
• Hepatitis C, Chronic (drug therapy)
• Heterocyclic Compounds, 4 or More Rings (economics, therapeutic use)
• Humans
• Lactams, Macrocyclic
• Leucine (analogs & derivatives)
• Macrocyclic Compounds (economics, therapeutic use)
• Markov Chains
• Proline (analogs & derivatives)
• Quinoxalines
• Sofosbuvir (economics, therapeutic use)
• State Medicine (organization & administration, statistics & numerical data)
• Sulfonamides (economics, therapeutic use)
• United Kingdom