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

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

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Antiviral Agents / adverse effects
  • Antiviral Agents / economics*
  • Antiviral Agents / therapeutic use*
  • Carcinoma, Hepatocellular / etiology
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Disease Progression
  • Drug Therapy, Combination
  • Female
  • Genotype
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / economics
  • Hepatitis C, Chronic / genetics*
  • Humans
  • Interferon-alpha / adverse effects
  • Interferon-alpha / economics
  • Interferon-alpha / therapeutic use
  • Interferons
  • Interleukins / genetics
  • Liver Cirrhosis / drug therapy
  • Liver Cirrhosis / economics
  • Liver Neoplasms / etiology
  • Male
  • Markov Chains
  • Medication Adherence
  • Protease Inhibitors / adverse effects
  • Protease Inhibitors / economics*
  • Protease Inhibitors / therapeutic use*
  • Quality-Adjusted Life Years
  • Ribavirin / adverse effects
  • Ribavirin / economics
  • Ribavirin / therapeutic use
  • Risk Factors
  • Treatment Outcome

Substances

  • Antiviral Agents
  • IFNL3 protein, human
  • Interferon-alpha
  • Interleukins
  • Protease Inhibitors
  • Ribavirin
  • Interferons