Cost-effectiveness analysis of simeprevir with daclatasvir for non-cirrhotic genotype-1b-naïve patients plus chronic hepatitis C.
BACKGROUND
The cost of interferon-free combination therapies remains high to provide widespread access to treatment, regardless of fibrosis stage.


OBJECTIVE
To estimate the cost-effectiveness of simeprevir/daclatasvir (SMV/DCV) therapy in treatment-naïve chronic hepatitis C genotype-1b patients with moderate fibrosis.


METHODS
A Markov model was developed to simulate the natural history of chronic hepatitis C progression. The model estimated lifetime healthcare costs and quality-adjusted life-years (QALY) for a cohort of patients from the Spanish National Healthcare System perspective. The cost-effectiveness threshold considered was €40,000/QALY. The treatment strategies analyzed were SMV/DCV, peginterferon/ribavirin/telaprevir, and peginterferon/ribavirin/boceprevir. A sensitivity analysis was carried out.


RESULTS
The incremental cost-effectiveness ratios of the SMV/DCV strategy were €23,774/QALY and €28,524/QALY compared with that of telaprevir or boceprevir triple therapy, respectively, for genotype-1b patients with moderate fibrosis.


CONCLUSIONS
SMV/DCV combination compared with the standard of care previous to the arrival of second-generation direct-acting antivirals fell below generally accepted willingness-to-pay threshold. Results obtained should be supported by ongoing clinical trials.
a 1 Hospital Universitario Miguel Servet-Pharmacy Department, Isabel la Católica 1-3, Zaragoza, Zaragoza 50009, Spain.|d 4 Faculty of Pharmacy, University of Granada, Granada, Spain.
Vicente
V
Gimeno-Ballester
b 2 Hospital Alto Deba-Clinical Management Service, Mondragón, Spain.
Javier
J
Mar
c 3 Complejo Hospitalario de Navarra-Pharmacy Department, Pamplona, Spain.|d 4 Faculty of Pharmacy, University of Granada, Granada, Spain.
Ramón
R
San Miguel
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002219:Carbamates; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005838:Genotype; D017048:Health Care Costs; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics / Q000821:virology; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008390:Markov Chains; D008875:Middle Aged; D011759:Pyrrolidines; D019057:Quality-Adjusted Life Years; D000069616:Simeprevir / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D014633:Valine / Q000031:analogs & derivatives
D000998:Antiviral Agents; D002219:Carbamates; D007093:Imidazoles; D011759:Pyrrolidines; D000069616:Simeprevir; D014633:Valine; C549273:daclatasvir
boceprevir; chronic hepatitis C; cost–effectiveness; daclatasvir; direct acting antivirals; pegylated interferon; protease inhibitors; ribavirin; simeprevir; telaprevir