title: [Cost-effectiveness and safety of telaprevir and boceprevir for chronic hepatitis C in real-world clinical practice].
abstract: BACKGROUND
  Triple therapy with telaprevir or boceprevir has proven to be effective in the treatment of chronic hepatitis C with response rates of up to 88%. However, the treatment may be associated with important adverse effects and a high economic impact.
  
  
  OBJECTIVE
  To assess the cost-effectiveness and safety of triple therapy with telaprevir or boceprevir for the treatment of chronic hepatitis C.
  
  
  METHODS
  Retrospective observational study. We included all patients who had started treatment with protease inhibitors before July 31(st), 2013. We evaluated sustained virological response, the cost per patient achieving sustained virological response, and the cost of the supportive treatment for adverse events associated with triple therapy.
  
  
  RESULTS
  Fifty-nine patients were included; 35 had been treated with telaprevir (59.3%) and 24 with boceprevir (40.7%). Sustained virological response was achieved by 38 (64.4%) patients: 24 (68.6%) patients in the telaprevir treatment arm and 14 (58.3%) patients in the boceprevir treatment arm. The cost per patient with sustained virological response was 43,555 € (95% CI 35,389-51,722 €). There were no statistically significant differences between the overall costs of therapy with telaprevir, 43,494 € (95% CI 34,795 €-55,092 €) versus boceprevir, 42,005 € (95% CI 32,122-64,243€). The mean cost of supportive care per patient was 1,500 €, while the maximum cost was 11,374 €. Due to adverse events, 8 (13.6%) patients required hospital admission, 22 (37.3%) patients attended the accident and emergency department, and 26 (44.1%) patients needed additional medical consultations.
  
  
  CONCLUSIONS
  The treatment of triple therapy with telaprevir or boceprevir resulted in high cost per patient with sustained virological response. Due to adverse events, a high number of patients required supportive care, whose costs should be added to those of triple therapy.
authors: Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: a.gimenezmanzorro@gmail.com.
authors: Álvaro
authors: Á
authors: Giménez-Manzorro
authors: Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Xandra
authors: X
authors: García-González
authors: Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Carmen Guadalupe
authors: CG
authors: Rodríguez-González
authors: Servicio Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Alejandra
authors: A
authors: Ochoa-Palominos
authors: Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: María
authors: M
authors: Sanjurjo-Sáez
authors: Servicio Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Gerardo
authors: G
authors: Clemente-Ricote
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced / Q000191:economics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007372:Interferons / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011392:Proline / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D012074:Remission Induction; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D013030:Spain
chemical_list: D000998:Antiviral Agents; D009842:Oligopeptides; D011480:Protease Inhibitors; D012254:Ribavirin; C486464:telaprevir; 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; D007372:Interferons; D011392:Proline
keywords: Antiviral agentes; Antivirales directos; Análisis coste-beneficio; Comparative effectiveness; Cost-benefit analysis; Direct antivirals; Efectividad comparativa; Hepatitis C; Inhibidores de proteasa; Interferon-alpha; Interferón alfa; Protease inhibitors; Ribavirin; Ribavirina; Toxicidad; Toxicity; Tratamiento antiviral; Triple terapia; Triple therapy