title: Cost-effectiveness of strategy-based approach to treatment of genotype 1 chronic hepatitis C.
abstract: OBJECTIVE
  The high cost of chronic hepatitis C (HCV) direct-acting antivirals (DAAs) poses significant financial challenges for health payers, especially in Asia. A personalized treatment strategy based on individualized probability of virological response using oral DAAs as second-line therapy would seem practical but has not been studied.
  
  
  METHODS
  We performed a Markov model to project health outcomes and costs for patients with genotype 1 HCV through 10 treatment strategies over a lifetime period. The implication of retreatment was also incorporated to reflect real-life situation.
  
  
  RESULTS
  Using boceprevir and peginterferon/ribavirin (BOC/PR, the least costly treatment) as a base case, the all-oral therapies such as ombitasvir/paritaprevir/ritonavir-dasabuvir are cost-effective with an incremental cost-effective ratio of $US50 828. However, the all-oral DAAs would no longer be cost-effective compared with conventional therapies if retreatment were taken into account. A road map strategy using rapid virological response to guide use of BOC/PR and sofosbuvir/PR had the most favorable incremental cost-effective ratio ($US27 782) relative to BOC/PR. Nevertheless, the trade-off with the cost-effectiveness of the road map strategy is an increased number of liver-related deaths compared with all-oral DAAs (52 vs 10-20 per 10 000 patients) by incorporating retreatment.
  
  
  CONCLUSIONS
  The 12-week all-oral DAAs were cost-effective options using conventional drug-to-drug comparison. However, they cease to be cost-effective when treatment strategies incorporating DAA retreatment for interferon failures are incorporated. HCV management can be optimized by adopting individualized treatment algorithm providing a practical solution to health payers to make oral DAAs accessible to those who need them most.
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Ying Jiao
authors.initials: YJ
authors.lastname: Zhao
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Ai Leng
authors.initials: AL
authors.lastname: Khoo
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Liang
authors.initials: L
authors.lastname: Lin
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Monica
authors.initials: M
authors.lastname: Teng
authors.affiliation: Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore.
authors.forename: Calvin J
authors.initials: CJ
authors.lastname: Koh
authors.affiliation: Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore.
authors.forename: Seng Gee
authors.initials: SG
authors.lastname: Lim
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Boon Peng
authors.initials: BP
authors.lastname: Lim
authors.affiliation: Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore. yock_young_dan@nuhs.edu.sg.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. yock_young_dan@nuhs.edu.sg.
authors.forename: Yock Young
authors.initials: YY
authors.lastname: Dan
mesh_terms: D000284:Administration, Oral; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001208:Asia; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000191:economics / Q000821:virology; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D057285:Precision Medicine / Q000191:economics; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D000072230:Sustained Virologic Response; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: cost-effectiveness; direct-acting antivirals; hepatitis C