title: The cost-effectiveness of improved hepatitis C virus therapies in HIV/hepatitis C virus coinfected patients.
abstract: OBJECTIVE
  To evaluate the effectiveness and cost-effectiveness of strategies to treat hepatitis C virus (HCV) in HIV/HCV coinfected patients in the United States.
  
  
  METHODS
  Simulated cohort of HIV/HCV genotype 1 coinfected, noncirrhotic, HCV treatment-naive individuals enrolled in US HIV guideline-concordant care.
  
  
  METHODS
  Monte Carlo simulation comparing five strategies: no treatment; dual therapy with pegylated-interferon (PEG) and ribavirin (RBV); 'PEG/RBV trial' in which all patients initiate dual therapy and switch to triple therapy upon failure; 'IL28B triage' in which patients initiate either dual therapy or triple therapy based on their IL28B allele type; and PEG/RBV and telaprevir (TPV) triple therapy. Sensitivity analyses varied efficacies and costs and included a scenario with interferon (IFN)-free therapy.
  
  
  METHODS
  Sustained virologic response (SVR), life expectancy, discounted quality-adjusted life expectancy (QALE), lifetime medical costs, and incremental cost-effectiveness ratios (ICERs) in $/quality-adjusted life years (QALY) gained.
  
  
  RESULTS
  'PEG/RBV trial,' 'IL28B triage,' and 'triple therapy' each provided 72% SVR and extended QALE compared with 'dual therapy' by 1.12, 1.14, and 1.15 QALY, respectively. The ICER of 'PEG/RBV trial' compared with 'dual therapy' was $37 500/QALY. 'IL28B triage' and 'triple therapy' provided little benefit compared with 'PEG/RBV trial,' and both had ICERs exceeding $300 000/QALY. In sensitivity analyses, IFN-free treatment attaining 90% SVR had an ICER less than $100 000/QALY compared with 'PEG/RBV trial' when its cost was $109 000 or less (125% of the cost of PEG/RBV/TVR).
  
  
  CONCLUSIONS
  HCV protease inhibitors are most efficiently used in HIV/HCV coinfection after a trial of PEG/RBV, sparing protease inhibitors for those who attain rapid virologic response and SVR. The cost-effectiveness of IFN-free regimens for HIV/HCV coinfection will depend on the cost of these therapies.
authors.affiliation: aSection of Infectious Diseases, Department of Medicine, Boston Medical Center bDepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts cDepartment of Public Health, Weill Cornell Medical College, New York, New York dDivision of General Medicine, Massachusetts General Hospital eDivision of Infectious Diseases, Massachusetts General Hospital fDepartment of Global Health and Population gDepartment of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Linas
authors.forename: Devra M
authors.initials: DM
authors.lastname: Barter
authors.forename: Jared A
authors.initials: JA
authors.lastname: Leff
authors.forename: Madeline
authors.initials: M
authors.lastname: DiLorenzo
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Charles R
authors.initials: CR
authors.lastname: Horsburgh
authors.forename: Sabrina A
authors.initials: SA
authors.lastname: Assoumou
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: Arthur Y
authors.initials: AY
authors.lastname: Kim
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics*; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000008:administration & dosage / Q000191:economics; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage / Q000191:economics; D012254:Ribavirin / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome; D014481:United States
chemical_list: D000998:Antiviral Agents; D009842:Oligopeptides; D012254:Ribavirin; C486464:telaprevir; D007372:Interferons