title: Cost utility of telaprevir-PR (peginterferon-ribavirin) versus boceprevir-PR and versus PR alone in chronic hepatitis C in The Netherlands.
abstract: BACKGROUND
  The hepatitis C virus may lead to cirrhosis, liver cancer, liver transplant, and increased mortality. With standard treatment peginterferon-alpha and ribavirin (PR), sustained viral response (SVR) was less than 50 %. SVR rates improve greatly when PR is combined with telaprevir or boceprevir.
  
  
  OBJECTIVE
  The aim of this study was to assess the cost utility of telaprevir-peginterferon-ribavirin (TPR) versus PR and boceprevir-peginterferon-ribavirin (BPR) in treatment-naïve (TN) and treatment-experienced (TE) adults with chronic hepatitis C in the Netherlands.
  
  
  METHODS
  A Markov model with a lifelong time horizon and annual cycles was developed. Clinical data stemmed from phase III trials (TPR vs PR, BPR vs PR). A mixed treatment comparison (MTC) was developed to compare TPR and BPR indirectly. Unit costs and utilities based on EQ-5D were established in a Dutch cross-sectional study. Cost per quality-adjusted life-years (QALYs) was calculated according to the societal perspective.
  
  
  RESULTS
  Treating TN patients with TPR generates 1.12 additional QALYs with €333 additional cost compared with PR, resulting in an incremental cost-utility ratio of €299/QALY. In TE patients, TPR dominates PR with cost savings (-€7,819) and 1.63 additional QALYs. TPR dominates BPR yielding additional QALYs (0.26 in TN; 0.71 in TE) and cost savings (-€7,296, -€18,144, respectively).
  
  
  CONCLUSIONS
  TPR seems a cost-effective alternative to PR in TN patients and dominant in TE patients. TPR was a dominant, more effective and less costly alternative to BPR in both patient types. The cost effectiveness of both TPR and BPR is well below generally accepted willingness-to-pay thresholds and may be considered cost effective.
authors.affiliation: Health Economics and Outcome Research Department, IMS Health, Medialaan 38, 1800, Vilvoorde, Belgium.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Vellopoulou
authors.forename: Michel
authors.initials: M
authors.lastname: van Agthoven
authors.forename: Annemarie
authors.initials: A
authors.lastname: van der Kolk
authors.forename: Robert J
authors.initials: RJ
authors.lastname: de Knegt
authors.forename: Gilles
authors.initials: G
authors.lastname: Berdeaux
authors.forename: Sandrine
authors.initials: S
authors.lastname: Cure
authors.forename: Florence
authors.initials: F
authors.lastname: Bianic
authors.forename: Mark
authors.initials: M
authors.lastname: Lamotte
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009426:Netherlands; D009842:Oligopeptides / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D011392:Proline / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D009842:Oligopeptides; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; 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; C100416:peginterferon alfa-2a