title: [Cost-utility analysis of triple therapy with telaprevir in treatment-naïve hepatitis C patients].
abstract: BACKGROUND
  The prevalence of Hepatitis C (HCV) in Spain is 2,5%, with a high morbimortality rate. Triple therapy based on telaprevir plus peginterferon/ribavirin ([T/PR]) has demonstrated to be an effective approach in treatment-naïve G1-HCV patients. This analysis evaluated, through a Markov model, the incremental cost-effectiveness ratio of triple therapy compared to peginterferon/ ribavirin ([PR]) alone in naïve patients depending on fibrosis stage, from the Spanish Healthcare Authorities perspective.
  
  
  METHODS
  Efficacy results and adverse events incidence were based on the combined results of ADVANCE and OPTIMIZE studies. Adverse events and disease-related costs (€, 2014) were built up from panel expert opinion except from transplant and post-transplant costs, taken from published data. Drug costs were obtained from national databases and adjusted for the mandatory deduction. Outcomes and costs were both discounted at 3%/year.
  
  
  RESULTS
  The analysis shows higher costs and improved outcomes associated with [TR/PR] relative to [PR] alone, resulting in an incremental cost-effectiveness ratio (ICER) of €18,288/ QALY for all the cohort, €14,152QALY for moderate fibrosis, €11,364QALY for bridging fibrosis, €15,929/QALY for cirrhosis. Over a lifetime period, the use of [T/PR] could avoid 12 cirrhosis and 4 liver transplants per 1,000 patients compared to [PR] alone. The probabilistic analysis, following 10,000 Montecarlo simulations, demonstrated the probability of an ICER below a €30,000/QALY gained threshold of 69%. At a willingness- to-pay of €30,000/QALY, [T/PR] could be considered as an efficient option compared with [PR] alone for treatment-naïve genotype 1 HCV patients, over a lifetime horizon.
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia, Madrid.. mbuti@vhebron.net.
authors.forename: María
authors.initials: M
authors.lastname: Buti
authors.affiliation: Hospital Vall d' Hebrón, Barcelona.. bgros@porib.com.
authors.forename: Blanca
authors.initials: B
authors.lastname: Gros
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia, Madrid.. ioyaguez@porib.com.
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
authors.affiliation: Hospital Universitario Virgen de la Victoria, Málaga.. andrade@uma.es.
authors.forename: Raúl J
authors.initials: RJ
authors.lastname: Andrade
authors.affiliation: Hospital Clínico de Valencia, Valencia. Universidad de Valencia, Valencia.. miguel.a.serra@uv.es.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Serra
authors.affiliation: Complejo Hospitalario Universitario de Pontevedra, Pontevedra. España.. jturnesv@gmail.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Turnes
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia, Madrid.. ma_casado@porib.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Casado
mesh_terms: D000740:Anemia / Q000139:chemically induced; D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery; D003362:Cost-Benefit Analysis; D003875:Drug Eruptions / Q000209:etiology; D004359:Drug Therapy, Combination / Q000191:economics; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology / Q000517:prevention & control; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation; D008390:Markov Chains; D009842:Oligopeptides / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015995:Prevalence; D019057:Quality-Adjusted Life Years; 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; D013030:Spain / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D009842:Oligopeptides; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C486464:telaprevir; C100416:peginterferon alfa-2a