title: A cost-effectiveness model to personalize antiviral therapy in naive patients with genotype 1 chronic hepatitis C.
abstract: OBJECTIVE
  Rapid virologic response is the best predictor of sustained virologic response with dual therapy in genotype-1 chronic hepatitis C, and its evaluation was proposed to tailor triple therapy in F0-F2 patients. Bio-mathematical modelling of viral dynamics during dual therapy has potentially higher accuracy than rapid virologic in the identification of patients who will eventually achieve sustained response. Study's objective was the cost-effectiveness analysis of a personalized therapy in naïve F0-F2 patients with chronic hepatitis C based on a bio-mathematical model (model-guided strategy) rather than on rapid virologic response (guideline-guided strategy).
  
  
  METHODS
  A deterministic bio-mathematical model of the infected cell dynamics was validated in a cohort of 135 patients treated with dual therapy. A decision-analytic economic model was then developed to compare model-guided and guideline-guided strategies in the Italian setting.
  
  
  RESULTS
  The outcomes of the cost-effectiveness analysis with model-guided and guideline-guided strategy were 19.1-19.4 and 18.9-19.3 quality-adjusted-life-years. Total per-patient lifetime costs were €25,200-€26,000 with model-guided strategy and €28,800-€29,900 with guideline-guided strategy. When comparing model-guided with guideline-guided strategy the former resulted more effective and less costly.
  
  
  CONCLUSIONS
  The adoption of the bio-mathematical predictive criterion has the potential to improve the cost-effectiveness of a personalized therapy for chronic hepatitis C, reserving triple therapy for those patients who really need it.
authors.affiliation: SIHS Health Economics Consulting, Torino, Italy. Electronic address: sergio.iannazzo@icloud.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Iannazzo
authors.affiliation: Hepatology-Unit, University Hospital (AOUP), Pisa, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Colombatto
authors.affiliation: Hepatology-Unit, University Hospital (AOUP), Pisa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Ricco
authors.affiliation: Hepatology-Unit, University Hospital (AOUP), Pisa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Oliveri
authors.affiliation: General Medicine II Digestive and Liver Disease Unit, University Hospital (AOUP), Pisa, Italy.
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Bonino
authors.affiliation: Hepatology-Unit, University Hospital (AOUP), Pisa, Italy.
authors.forename: Maurizia R
authors.initials: MR
authors.lastname: Brunetto
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D017048:Health Care Costs; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D007558:Italy; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin
keywords: Chronic hepatitis C; Cost-effectiveness; Dual therapy; Triple therapy