title: New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis.
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.
  
  
  METHODS
  Decision-analytic Markov model.
  
  
  METHODS
  Published literature and expert opinion.
  
  
  METHODS
  Treatment-naive patients with chronic, genotype 1 hepatitis C virus monoinfection.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  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.
  
  
  METHODS
  Discounted costs (in 2010 U.S. dollars) and quality-adjusted life-years (QALYs); incremental cost-effectiveness ratios.
  
  
  RESULTS
  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
  Results were sensitive to the cost of protease inhibitors and treatment adherence rates.
  
  
  CONCLUSIONS
  Data on the long-term comparative effectiveness of the new protease inhibitors are lacking.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Stanford University.
authors.affiliation: Center for Health Policy, Stanford University, CA, USA.
authors.forename: Shan
authors.initials: S
authors.lastname: Liu
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cipriano
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics / Q000235:genetics*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D007372:Interferons; D007378:Interleukins / Q000235:genetics; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000191:economics; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008390:Markov Chains; D055118:Medication Adherence; D011480:Protease Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome; D000095022:Interferon Lambda
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D007372:Interferons; D007378:Interleukins; D011480:Protease Inhibitors; D012254:Ribavirin; C000624353:interferon-lambda, human; D000095022:Interferon Lambda