title: Cost-effectiveness of boceprevir or telaprevir for previously treated patients with genotype 1 chronic hepatitis C.
abstract: OBJECTIVE
  Randomised controlled trials (RCTs) show that triple therapy (TT) with peginterferon alfa, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of genotype 1 (G1) chronic hepatitis C (CHC) patients with previous relapse (RR), partial response (PAR), and null-response (NR). We assess the cost-effectiveness of TT compared to no therapy in the treatment of patients previously treated with G1 CHC.
  
  
  METHODS
  The available published literature provided the data source. The target population was made up of previously treated Caucasian patients with G1 CHC and these were evaluated over a lifetime horizon by Markov model. The study was carried out from the perspective of the Italian National Health Service. Outcomes included discounted costs (in euro at 2012 value), life years gained (LYG), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER).The robustness of the results was evaluated by one-way deterministic and multivariable probabilistic sensitivity analyses.
  
  
  RESULTS
  In RR patients, ICER per LYG compared to no therapy was €9555 for BOC-LEAD-IN-RR and €7910 for TVR-LEAD-IN-RR, being BOC dominated by TVR. In PAR patients, ICER for LYG was €11,947 for BOC-LEAD-IN-PAR and €14,931 for TVR-PAR, being TVR cost-effective compared to BOC (ICER for QALY €22,258). In NR patients, ICER for LYG was €26,499 for TVR-LEAD-IN-NR. The models were sensitive to likelihood of sustained virological response and to BOC/TVR prices.
  
  
  CONCLUSIONS
  1st generation HCV PI is highly cost-effective compared to no therapy in RR and PAR G1 CHC patients. TVR dominated BOC in RR, and was cost-effective compared to BOC in PAR patients. In NR patients an assessment of the response after a lead-in period should be performed to improve safety and cost-effectiveness.
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy. Electronic address: calogero.camma@unipa.it.
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cabibbo
authors.forename: Matteo
authors.initials: M
authors.lastname: Ruggeri
authors.forename: Marco
authors.initials: M
authors.lastname: Enea
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bruno
authors.forename: Vincenza
authors.initials: V
authors.lastname: Capursi
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Alfredo
authors.initials: A
authors.lastname: Alberti
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000191:economics* / Q000821:virology; D006801:Humans; D007558:Italy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009842:Oligopeptides / Q000191:economics* / Q000627:therapeutic use; D011392:Proline / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents; 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
keywords: BOC; Boceprevir; CHC; Cost-effectiveness; DT; G1; ICER; NR; PAR; PI; PegIFN; RBV; RR; TVR; Telaprevir; boceprevir; chronic hepatitis C; dual therapy; genotype 1; incremental cost-effectiveness ratio; non-response; partial response; pegylated interferon; protease inhibitors; relapse; ribavirin; telaprevir