title: Cost-effectiveness of boceprevir or telaprevir for untreated patients with genotype 1 chronic hepatitis C.
abstract: Randomized controlled trials (RCTs) show that triple therapy (TT) with peginterferon alpha, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of previously untreated patients with genotype 1 (G(1) ) chronic hepatitis C (CHC). We assessed the cost-effectiveness of TT compared to DT in the treatment of untreated patients with G(1) CHC. We created a Markov Decision Model to evaluate, in untreated Caucasian patients age 50 years, weight 70 kg, with G(1) CHC and Metavir F2 liver fibrosis score, for a time horizon of 20 years, the cost-effectiveness of the following five competing strategies: 1) boceprevir response-guided therapy (BOC-RGT); 2) boceprevir IL28B genotype-guided strategy (BOC-IL28B); 3) boceprevir rapid virologic response (RVR)-guided strategy (BOC-RVR); 4) telaprevir response-guided therapy (TVR-RGT); 5) telaprevir IL28B genotype-guided strategy (TVR-IL28B). Outcomes included life-years gained (LYG), costs (in 2011 euros) and incremental cost-effectiveness ratio (ICER). In the base-case analysis BOC-RVR and TVR-IL28B strategies were the most effective and cost-effective of evaluated strategies. LYG was 4.04 with BOC-RVR and 4.42 with TVR-IL28B. ICER compared with DT was € 8.304 per LYG for BOC-RVR and € 11.455 per LYG for TVR-IL28B. The model was highly sensitive to IL28B CC genotype, likelihood of RVR and sustained virologic response, and BOC/TVR prices.
  
  
  CONCLUSIONS
  In untreated G(1) CHC patients age 50 years, TT with first-generation protease inhibitors is cost-effective compared with DT. Multiple strategies to reduce costs and improve effectiveness include RVR or genotype-guided treatment.
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy. calogero.camma@unipa.it
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.forename: Marco
authors.initials: M
authors.lastname: Enea
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bruno
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bronte
authors.forename: Vincenza
authors.initials: V
authors.lastname: Capursi
authors.forename: Americo
authors.initials: A
authors.lastname: Cicchetti
authors.forename: Giorgio L
authors.initials: GL
authors.lastname: Colombo
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
mesh_terms: D003362:Cost-Benefit Analysis; D005838:Genotype; D006526:Hepatitis C / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000191:economics* / Q000627:therapeutic use*; D011392:Proline / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D009842:Oligopeptides; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D011392:Proline