title: A cost utility analysis of simeprevir used with peginterferon + ribavirin in the management of genotype 1 hepatitis C virus infection, from the perspective of the UK National Health Service.
abstract: BACKGROUND
  Triple therapy using a protease inhibitor (PI) with peginterferon and ribavirin (PR) is increasingly used in patients with chronic hepatitis C virus (HCV) infection. The most recently introduced PI, simeprevir (SMV), offers high levels of viral eradication combined with a reduced overall duration of therapy. The objective of this study was to compare the cost-effectiveness of SMV + PR vs PR alone or in combination with telaprevir (TVR) or boceprevir (BOC) in patients infected with genotype 1 HCV Method: A cost-utility model was constructed, incorporating two phases, capturing the efficacy of therapy in an initial treatment phase, followed by a long-term post-treatment Markov phase, capturing lifetime outcomes according to whether a sustained viral response (SVR) had been achieved on treatment. Dosage regimens were based on the EMA approved label for each treatment. SVR estimates and adverse event rates were derived from a mixed treatment comparison. Baseline characteristics were drawn from an analysis of a UK HCV data-set and clinician opinion. Health state transition probabilities, utilities, and health state costs were drawn from previously published economic analyses. The model considered direct health costs only, and the perspective was that of the UK National Health Service.
  
  
  RESULTS
  The model yielded an ICER for SMV + PR vs PR alone of £9725/QALY for treatment-naïve and £7819/QALY for treatment-experienced. Benefit was driven by increased likelihood of achieving SVR, with consequent long-term utility gains. SMV + PR dominated TVR + PR and BOC + PR in both patient groups. This principally reflected the QALY benefit of an increased likelihood of SVR with SMV, combined with lower overall drug costs, due to reduced mean treatment duration.
  
  
  CONCLUSIONS
  Compared to other currently licensed treatment options, SMV + PR represents a cost effective treatment option for patients with chronic genotype 1 HCV infection.
authors.affiliation: a a Pharmerit , Rotterdam , The Netherlands.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Westerhout
authors.affiliation: a a Pharmerit , Rotterdam , The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Treur
authors.affiliation: b b Janssen EMEA , Beerse Belgium.
authors.forename: Angelika
authors.initials: A
authors.lastname: Mehnert
authors.affiliation: c c Janssen , High Wycombe UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Pascoe
authors.affiliation: c c Janssen , High Wycombe UK.
authors.forename: Imran
authors.initials: I
authors.lastname: Ladha
authors.affiliation: d d JB Medical , Sudbury , UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Belsey
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects* / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000191:economics* / Q000235:genetics; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011480:Protease Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000069616:Simeprevir / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D013222:State Medicine / Q000191:economics; D006113:United Kingdom
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011480:Protease Inhibitors; D012254:Ribavirin; D000069616:Simeprevir
keywords: Boceprevir; Cost utility analysis; Health economics; Hepatitis C; Protease inhibitors; Simeprevir; Telaprevir