title: Cost-effectiveness of telaprevir in combination with pegylated interferon alpha and ribavirin in previously untreated chronic hepatitis C genotype 1 patients.
abstract: BACKGROUND
  Telaprevir (T, TVR) is a direct-acting antiviral (DAA) used for the treatment of genotype 1 chronic hepatitis C virus (HCV) infection. The sustained virological response (SVR) rates, i.e., undetectable HCV RNA levels 24 weeks after the end of treatment, is what differentiate treatments. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV), with Peg-IFN and RBV (PR) alone or with boceprevir (B, BOC) plus Peg-IFN alfa-2b and RBV, in naïve patients.
  
  
  METHODS
  A Markov cohort model of chronic HCV disease progression reflected the pathway of naïve patients initiating anti-HCV therapy. SVR rates were derived from a mixed-treatment comparison including results from Phase II and III trials of TVR and BOC, and trials comparing both PR regimens. SVR has significant impact on survival, quality-of-life, and costs. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the (National Health Service) NHS perspective. Cost and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were also performed by interleukin (IL)-28B genotype and fibrosis stage.
  
  
  RESULTS
  Higher costs and improved outcomes were associated with T/PR relative to PR alone, resulting in an ICER of £12,733 per QALY gained. T/PR retained a significant SVR advantage over PR alone and was cost-effective regardless of IL-28B genotype and fibrosis stages. T/PR regimen 'dominated' B/PR, generating 0.2 additional QALYs and reducing lifetime cost by £2758. Sensitivity analyses consistently resulted in ICERs less than £30,000/QALY for the T/PR regimen over PR alone.
  
  
  CONCLUSIONS
  No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR.
  
  
  CONCLUSIONS
  The introduction of TVR-based therapy for genotype 1 HCV patients is cost-effective for naïve patients at the £30,000 willingness-to-pay threshold, regardless of IL-28B genotype or fibrosis stage.
authors.affiliation: OptumInsight , Uxbridge , UK.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Cure
authors.forename: Florence
authors.initials: F
authors.lastname: Bianic
authors.forename: Sandra
authors.initials: S
authors.lastname: Gavart
authors.forename: Steve
authors.initials: S
authors.lastname: Curtis
authors.forename: Seina
authors.initials: S
authors.lastname: Lee
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dusheiko
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D016174:Hepacivirus / Q000187:drug effects; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D009842:Oligopeptides / Q000191:economics* / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000191:economics* / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000191:economics* / Q000627:therapeutic use; D016019:Survival Analysis
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D009842:Oligopeptides; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C486464:telaprevir; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a