title: Cost-effectiveness of Interferon-free therapy for Hepatitis C in Germany--an application of the efficiency frontier approach.
abstract: BACKGROUND
  The approval of direct-acting antivirals for Interferon-free treatment revolutionized the therapy of chronic Hepatitis C infection. As of August 2014, two treatment regimens for genotype 1 infection received conditional approval in the European Union: Sofosbuvir and Ribavirin for 24 weeks and Sofosbuvir and Simeprevir with or without Ribavirin for 12 weeks. We aim to analyze the cost-effectiveness of both regimens in Germany.
  
  
  METHODS
  We set up a Markov model with a lifetime horizon to simulate immediate treatment success and long-term disease progression for treatment-naive patients. The model analyzes both short-term and long-term costs and benefits from the perspective of the German Statutory Health Insurance. We apply the efficiency frontier method, which was suggested by German Institute for Quality and Efficiency in Health Care for cost-effectiveness analysis in Germany.
  
  
  RESULTS
  The efficiency frontier is defined by dual therapy and first generation direct-acting antiviral Boceprevir, yielding a maximum of € 1,447.69 per additional percentage point of sustained virologic response gained. Even without rebates, Sofosbuvir/Simeprevir is very close with € 1,560.13 per additional percentage point. It is both more effective and less expensive than Sofosbuvir/Ribavirin.
  
  
  CONCLUSIONS
  In addition to higher sustained virologic response rates, new direct-acting antivirals save long-term costs by preventing complications such as liver cirrhosis, hepatocellular carcinoma and ultimately liver transplants, thereby offsetting part of higher drug costs. Our findings are in line with the guidance published by German Society for Gastroenterology, Digestive and Metabolic Diseases, which recommends Sofosbuvir/Simeprevir for Interferon ineligible or intolerant patients.
authors.affiliation: Department of Economics and Business, Justus Liebig University Giessen, Giessen, Germany. cg@phec.de.|General Medicine, Department of Medicine, Justus Liebig University Giessen, Klinikstrasse 32, 35392, Giessen, Germany. cg@phec.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Gissel
authors.affiliation: Department of Economics and Business, Justus Liebig University Giessen, Giessen, Germany. Georg.Goetz@wirtschaft.uni-giessen.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Götz
authors.affiliation: Janssen Pharmaceutical K.K., 5-2, Nishi-kanda 3-chome, Chiyoda-ku, Tokyo, 101-0065, Japan. jmahlich@its.jnj.com.|Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany. jmahlich@its.jnj.com.
authors.forename: Jörg
authors.initials: J
authors.lastname: Mahlich
authors.affiliation: General Medicine, Department of Medicine, Justus Liebig University Giessen, Klinikstrasse 32, 35392, Giessen, Germany. repp@phec.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Repp
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D008297:Male; D011392:Proline / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D000069616:Simeprevir / Q000191:economics / Q000627:therapeutic use; D000069474:Sofosbuvir / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; 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; D000069616:Simeprevir; D000069474:Sofosbuvir