title: Costs of telaprevir-based triple therapy for hepatitis C: $189,000 per sustained virological response.
abstract: In registration trials, triple therapy with telaprevir (TVR), pegylated interferon (Peg-IFN), and ribavirin (RBV) achieved sustained virological response (SVR) rates between 64% and 75%, but the clinical effectiveness and economic burdens of this treatment in real-world practice remain to be determined. Records of 147 patients who initiated TVR-based triple therapy at the Mount Sinai Medical Center (May-December 2011) were reviewed. Direct medical costs for pretreatment, on-treatment, and posttreatment care were calculated using data from Medicare reimbursement databases, RED Book, and the Healthcare Cost and Utilization Project database. Costs are presented in 2012 U.S. dollars. SVR (undetectable hepatitis C virus [HCV] RNA 24 weeks after the end of treatment) was determined on an intention-to-treat basis. Cost per SVR was calculated by dividing the median cost by the SVR rate. Median age of the 147 patients was 56 years (interquartile range [IQR] = 51-61), 68% were male, 19% were black, 11% had human immunodeficiency virus/HCV coinfection, 36% had advanced fibrosis/cirrhosis (FIB-4 scores ≥3.25), and 44% achieved an SVR. The total cost of care was $11.56 million. Median cost of care was $83,721 per patient (IQR = $66,652-$98,102). The median cost per SVR was $189,338 (IQR = $150,735-$221,860). Total costs were TVR (61%), IFN (24%), RBV (4%), adverse event management (8%), professional fees (2%), and laboratory tests (1%).
  
  
  CONCLUSIONS
  TVR and Peg-IFN accounted for 85% of costs. Pharmaceutical prices and the low (44%) SVR rate, in this real-world study, were major contributors to the high cost per SVR.
authors: Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Kian
authors: K
authors: Bichoupan
authors: Valerie
authors: V
authors: Martel-Laferriere
authors: David
authors: D
authors: Sachs
authors: Michel
authors: M
authors: Ng
authors: Emily A
authors: EA
authors: Schonfeld
authors: Alexis
authors: A
authors: Pappas
authors: James
authors: J
authors: Crismale
authors: Alicia
authors: A
authors: Stivala
authors: Viktoriya
authors: V
authors: Khaitova
authors: Donald
authors: D
authors: Gardenier
authors: Michael
authors: M
authors: Linderman
authors: Ponni V
authors: PV
authors: Perumalswami
authors: Thomas D
authors: TD
authors: Schiano
authors: Joseph A
authors: JA
authors: Odin
authors: Lawrence
authors: L
authors: Liu
authors: Alan J
authors: AJ
authors: Moskowitz
authors: Douglas T
authors: DT
authors: Dieterich
authors: Andrea D
authors: AD
authors: Branch
mesh_terms: D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017281:Cost of Illness; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D016174:Hepacivirus / Q000187:drug effects / Q000502:physiology; D006526:Hepatitis C / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D016898:Interferon-alpha / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000494:pharmacology / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012254:Ribavirin / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects; D014779:Virus Replication / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D009842:Oligopeptides; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C486464:telaprevir; C100416:peginterferon alfa-2a