title: Boceprevir for Chronic Genotype 1 Hepatitis C Virus in the Current Health Care Setting in Greece: A Cost-effectiveness Analysis.
abstract: OBJECTIVE
  Boceprevir, as an add-on to the standard of care (SOC) for chronic genotype 1 hepatitis C virus (G1 HCV), pegylated interferon + ribavirin for 48 weeks (PEG + RBV), has been reported to have a clinical profile superior to that of SOC alone. The objective of the present study was to compare the cost-effectiveness of triple therapy with PEG + RBV + boceprevir to that of SOC in treatment-naive and treatment-experienced patients with G1 HCV in Greece.
  
  
  METHODS
  A Markov model that simulated the quality-adjusted life expectancy and corresponding costs of treating G1 HCV infection provided the basis of the analysis. Treatment strategies under consideration were those in the Phase III boceprevir trials: (1) boceprevir response-guided therapy (shortened treatment duration for early responders); (2) fixed-duration (4-week) SOC plus 44 weeks of triple therapy; and (3) 48-week SOC. Efficacy data and the baseline characteristics of the study population were based on data from the SPRINT-2 (Serine Protease Inhibitor Therapy 2) and RESPOND-2 (Retreatment with HCV Serine Protease Inhibitor Boceprevir and PegIntron/Rebetol 2) clinical trials. Health care resource utilization and costs reflect the local clinical setting, with a 3% discount per annum, and were assessed from a third-party payer perspective.
  
  
  RESULTS
  Triple therapy was projected to reduce liver complications (eg, decompensated cirrhosis, hepatocellular carcinoma, need for liver transplantation, and liver-related death) by 44% to 45% and 49% to 53% in treatment-naive and treatment-experienced patients, respectively, over a lifetime horizon, leading to corresponding gains of 0.87 and 1.25 quality-adjusted life-years gained per patient. Taking into account the costs of medications, treatment, and outcomes management, the estimated incremental cost-effectiveness ratios of triple therapy versus SOC were €10,003 and €10,852 per quality-adjusted life-years gained in treatment-naïve and treatment-experienced patients. Extensive sensitivity analyses suggested that the findings were robust over a wide range of inputs.
  
  
  CONCLUSIONS
  Based on the findings from the present analysis, the addition of boceprevir to PEG + RBV for the treatment of patients with G1 HCV may be a cost-effective alternative in the health care setting in Greece.
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Athanasakis
authors.affiliation: Merck Sharp & Dohme Corporation, Whitehouse Station, New Jersey.
authors.forename: Shannon Allen
authors.initials: SA
authors.lastname: Ferrante
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece. Electronic address: ilias.kyriopoulos@gmail.com.
authors.forename: Ilias-Ioannis
authors.initials: II
authors.lastname: Kyriopoulos
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Petrakis
authors.affiliation: MSD Hellas, Athens, Greece.
authors.forename: Mary
authors.initials: M
authors.lastname: Hill
authors.affiliation: MSD Hellas, Athens, Greece.
authors.forename: Maria-Pagona
authors.initials: MP
authors.lastname: Retsa
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
mesh_terms: D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics / Q000401:mortality / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008017:Life Expectancy; D008390:Markov Chains; D017059:Models, Econometric; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D011392:Proline / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D012680:Sensitivity and Specificity
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; 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; C417083:peginterferon alfa-2b
keywords: boceprevir; chronic hepatitis C; cost-effectiveness; genotype 1; pegylated interferon; ribavirin