title: Cost Effectiveness of Daclatasvir/Asunaprevir Versus Peginterferon/Ribavirin and Protease Inhibitors for the Treatment of Hepatitis c Genotype 1b Naïve Patients in Chile.
abstract: BACKGROUND
  Daclatasvir and Asunaprevir (DCV/ASV) have recently been approved for the treatment of chronic hepatitis C virus infection. In association, they are more effective and safer than previous available treatments, but more expensive. It is unclear if paying for the additional costs is an efficient strategy considering limited resources.
  
  
  METHODS
  A Markov model was built to estimate the expected costs in Chilean pesos (CL$) and converted to US dollars (US$) and benefits in quality adjusted life years (QALYs) in a hypothetic cohort of naive patients receiving DCV/ASV compared to protease inhibitors (PIs) and Peginterferon plus Ribavirin (PR). Efficacy was obtained from a mixed-treatment comparison study and costs were estimated from local sources. Utilities were obtained applying the EQ-5D survey to local patients and then valued with the Chilean tariff. A time horizon of 46 years and a discount rate of 3% for costs and outcomes was considered. The ICERs were estimated for a range of DCV/ASV prices. Deterministic and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  PIs were extendedly dominated by DCV/ASV. The ICER of DCV/ASV compared to PR was US$ 16,635/QALY at a total treatment price of US$ 77,419; US$11,581 /QALY at a price of US$ 58,065; US$ 6,375/QALY at a price of US$ 38,710; and US$ 1,364 /QALY at a price of US$ 19,355. The probability of cost-effectiveness at a price of US$ 38,710 was 91.6% while there is a 21.43% probability that DCV/ASV dominates PR if the total treatment price was US$ 19,355. Although the results are sensitive to certain parameters, the ICER did not increase above the suggested threshold of 1 GDP per capita.
  
  
  CONCLUSIONS
  DCV/ASV can be considered cost-effective at any price of the range studied. These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system.
authors.affiliation: Centre of Clinical Research, Health Technology Assessment Unit, Pontificia Universidad Catolica de Chile, Santiago, Chile.
authors.forename: Constanza L
authors.initials: CL
authors.lastname: Vargas
authors.affiliation: Centre of Clinical Research, Health Technology Assessment Unit, Pontificia Universidad Catolica de Chile, Santiago, Chile.|Department of Public Health, Pontificia Universidad Catolica de Chile, Santiago, Chile.
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Espinoza
authors.affiliation: Hospital Sotero del Río, Puente Alto, Santiago, Chile.
authors.forename: Andrés
authors.initials: A
authors.lastname: Giglio
authors.affiliation: Centre of Clinical Research, Health Technology Assessment Unit, Pontificia Universidad Catolica de Chile, Santiago, Chile.|Department of Gastroenterology, Pontificia Universidad Catolica de Chile, Santiago Chile.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Soza
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D002219:Carbamates; D002677:Chile; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics* / Q000502:physiology*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D007546:Isoquinolines / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011336:Probability; D011480:Protease Inhibitors / Q000627:therapeutic use; D011759:Pyrrolidines; D011788:Quality of Life; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives
chemical_list: D000998:Antiviral Agents; D002219:Carbamates; D007093:Imidazoles; D016898:Interferon-alpha; D007546:Isoquinolines; D011480:Protease Inhibitors; D011759:Pyrrolidines; D011994:Recombinant Proteins; D013449:Sulfonamides; D011092:Polyethylene Glycols; D012254:Ribavirin; D014633:Valine; C549273:daclatasvir; C100416:peginterferon alfa-2a; C571889:asunaprevir