title: Cost-effectiveness of Ombitasvir/Paritaprevir/Ritonavir, Dasabuvir+Ribavirin for US Post-Liver Transplant Recurrent Genotype 1 HCV.
abstract: OBJECTIVE
  Orthotopic liver transplant patients with recurrent hepatitis C (HCV) historically have had limited treatment options. Ombitasvir/paritaprevir/ritonavir, dasabuvir and ribavirin (3D+R) was approved by the FDA in December 2014 for liver transplant recipients with recurrent genotype 1 HCV, in whom it is effective and well-tolerated.
  
  
  METHODS
  Using a two-phase Markov model, we analysed the cost-effectiveness of 3D+R in liver transplant recipients, the only HCV treatment with FDA approval in this population. As a sensitivity analysis, we also considered the cost-effectiveness of pegylated interferon plus ribavirin, the only other therapy with data from Phase III trials in this population. Patients were given one of three options: 3D+R for 24 weeks, pegylated interferon and ribavirin for 48 weeks (PR48) or no treatment (NT). Patients were then followed through subsequent disease progression until death. Outcome measures analysed were: lifetime risks of liver morbidity and mortality, treatment costs, non-treatment medical expenditures, and quality-adjusted life years.
  
  
  RESULTS
  Treatment with 3D+R was associated with a significantly lower lifetime risk of liver-related morbidity and mortality than treatment with PR48 or NT. 3D+R also was associated with a higher gain in quality-adjusted life years (11.3 compared to 8.25 with NT) and lower discounted overall costs ($423,585 compared to $724,757 with NT).
  
  
  CONCLUSIONS
  The use of 3D+R for liver transplant recipients with recurrent HCV is an outcome-improving and cost-effective regimen for this population with limited treatment options and large unmet need.
authors.affiliation: Pfleger Liver Institute, University of California, Los Angeles, California, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: AbbVie Inc., North Chicago, Illinois, USA.
authors.forename: Yuri S
authors.initials: YS
authors.lastname: Gonzalez
authors.affiliation: Precision Health Economics, Los Angeles, California, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Huber
authors.affiliation: AbbVie Inc., North Chicago, Illinois, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Wang
authors.affiliation: AbbVie Inc., North Chicago, Illinois, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Juday
mesh_terms: D015081:2-Naphthylamine; D000813:Anilides / Q000191:economics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D002219:Carbamates / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects* / Q000235:genetics; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D047029:Lactams, Macrocyclic; D016031:Liver Transplantation / Q000009:adverse effects* / Q000191:economics* / Q000401:mortality; D047028:Macrocyclic Compounds / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D010641:Phenotype; D011392:Proline / Q000031:analogs & derivatives; D012008:Recurrence; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D019438:Ritonavir / Q000191:economics / Q000627:therapeutic use; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014498:Uracil / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D014633:Valine; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000813:Anilides; D000998:Antiviral Agents; D002219:Carbamates; D003521:Cyclopropanes; D047029:Lactams, Macrocyclic; D047028:Macrocyclic Compounds; D013449:Sulfonamides; C586094:ombitasvir; D012254:Ribavirin; D014498:Uracil; D011392:Proline; D015081:2-Naphthylamine; C588260:dasabuvir; D014633:Valine; D019438:Ritonavir; C585405:paritaprevir
keywords: dasabuvir; hepatic; ombitasvir; paritaprevir; transplantation