title: Cost-effectiveness of currently recommended direct-acting antiviral treatments in patients infected with genotypes 1 or 4 hepatitis C virus in the US.
abstract: OBJECTIVE
  This study compared the cost-effectiveness of direct-acting antiviral therapies currently recommended for treating genotypes (GT) 1 and 4 chronic hepatitis C (CHC) patients in the US.
  
  
  METHODS
  A cost-effectiveness analysis of treatments for CHC from a US payer's perspective over a lifelong time horizon was performed. A Markov model based on the natural history of CHC was used for a population that included treatment-naïve and -experienced patients. Treatment alternatives considered for GT1 included ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (3D ± R), sofosbuvir + ledipasvir (SOF/LDV), sofosbuvir + simeprevir (SOF + SMV), simeprevir + pegylated interferon/ribavirin (SMV + PR) and no treatment (NT). For GT4 treatments, ombitasvir/paritaprevir/ritonavir + ribavirin (2D + R), SOF/LDV and NT were compared. Transition probabilities, utilities and costs were obtained from published literature. Outcomes included rates of compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC) and liver-related death (LrD), total costs, life-years and quality-adjusted life-years (QALYs). Costs and QALYs were used to calculate incremental cost-effectiveness ratios.
  
  
  RESULTS
  In GT1 patients, 3D ± R and SOF-containing regimens have similar long-term outcomes; 3D ± R had the lowest lifetime risks of all liver disease outcomes: CC = 30.2%, DCC = 5.0 %, HCC = 6.8%, LT = 1.9% and LrD = 9.2%. In GT1 patients, 3D ± R had the lowest cost and the highest QALYs. As a result, 3D ± R dominated these treatment options. In GT4 patients, 2D + R had lower rates of liver morbidity and mortality, lower cost and more QALYs than SOF/LDV and NT.
  
  
  CONCLUSIONS
  While the results are based on input values, which were obtained from a variety of heterogeneous sources-including clinical trials, the findings were robust across a plausible range of input values, as demonstrated in probabilistic sensitivity analyses.
  
  
  CONCLUSIONS
  Among currently recommended treatments for GT1 and GT4 in the US, 3D ± R (for GT1) and 2D + R (for GT4) have a favorable cost-effectiveness profile.
authors.affiliation: a UCLA, Pfleger Liver Institute , Los Angeles , CA , USA ;
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: b Medicus Economics LLC , Milton , MA, USA ;
authors.forename: Hélène
authors.initials: H
authors.lastname: Parisé
authors.affiliation: b Medicus Economics LLC , Milton , MA, USA ;
authors.forename: Suchin
authors.initials: S
authors.lastname: Virabhak
authors.affiliation: c AbbVie, Health Economics and Outcomes Research , Mettawa , IL, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Wang
authors.affiliation: c AbbVie, Health Economics and Outcomes Research , Mettawa , IL, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Marx
authors.affiliation: c AbbVie, Health Economics and Outcomes Research , Mettawa , IL, USA.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Sanchez Gonzalez
authors.affiliation: c AbbVie, Health Economics and Outcomes Research , Mettawa , IL, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Misurski
authors.affiliation: b Medicus Economics LLC , Milton , MA, USA ;
authors.forename: Scott
authors.initials: S
authors.lastname: Johnson
mesh_terms: D015081:2-Naphthylamine; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000813:Anilides / Q000191:economics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use; D002219:Carbamates / Q000191:economics / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005260:Female; D005355:Fibrosis / Q000191:economics / Q000453:epidemiology; D005449:Fluorenes / Q000191:economics / Q000627:therapeutic use; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D047029:Lactams, Macrocyclic; D008113:Liver Neoplasms / Q000191:economics / Q000453:epidemiology; D047028:Macrocyclic Compounds / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D011392:Proline / Q000031:analogs & derivatives; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D000069616:Simeprevir; D000069474:Sofosbuvir / Q000191:economics / Q000627:therapeutic use; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use; D014498:Uracil / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D014633:Valine
chemical_list: D000813:Anilides; D000998:Antiviral Agents; D001562:Benzimidazoles; D002219:Carbamates; D003521:Cyclopropanes; D005449:Fluorenes; D047029:Lactams, Macrocyclic; D047028:Macrocyclic Compounds; D013449:Sulfonamides; C586541:ledipasvir; C586094:ombitasvir; D012254:Ribavirin; D014498:Uracil; D011392:Proline; D000069616:Simeprevir; D015081:2-Naphthylamine; C588260:dasabuvir; D014633:Valine; C585405:paritaprevir; D000069474:Sofosbuvir
keywords: Hepatitis C virus; cost-effectiveness; direct-acting antivirals; markov model