title: Cost-Effectiveness of Genotype 1 Chronic Hepatitis C Virus Treatments in Patients Coinfected with Human Immunodeficiency Virus in the United States.
abstract: New treatments for chronic hepatitis C virus (HCV) are highly effective in patients coinfected with human immunodeficiency virus (HIV). This study estimated the cost-effectiveness of treatments for genotype 1 (GT1) HCV in HIV-coinfected patients.
  
  
  
  A Markov model based on HCV natural history was used. The base-case analysis included both treatment-naïve and -experienced patients. Alternatives were ombitasvir/paritaprevir/ritonavir, dasabuvir with or without ribavirin (3D ± R) for 12 or 24 weeks, sofosbuvir plus peginterferon and R (SOF + PR) for 12 weeks, SOF + R for 24 weeks, and no treatment (NT). A subgroup analysis restricted to treatment-naïve, non-cirrhotic patients compared 3D ± R for 12 weeks to SOF plus ledipasvir (LDV) for 12 weeks and NT. Transition probabilities, utilities, and costs were obtained from the published literature. Outcomes were measured over a lifetime horizon and included rates of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver-related death, total costs, life-years, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER).
  
  
  
  In the base-case, SOF + R was dominated by both SOF + PR and 3D ± R. Compared to SOF + PR, 3D ± R had an ICER of $45,581. The lifetime rates of liver morbidity and mortality were lower among those treated with 3D ± R compared to SOF + PR, SOF + R, or NT. In the subgroup analysis, 3D ± R was cost-effective compared to NT at a threshold of $50,000 per QALY (ICER $27,496). SOF/LDV had an ICER of $104,489 per QALY gained compared to 3D ± R.
  
  
  
  In the GT1 HCV population coinfected with HIV, 3D ± R was cost-effective compared to NT, SOF + R, and SOF + PR. In the treatment-naïve sub-population, 3D ± R was cost-effective compared to NT and SOF/LDV.
authors.affiliation: Pfleger Liver Institute, UCLA, Los Angeles, CA, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Medicus Economics LLC, Milton, MA, USA.
authors.forename: Suchin
authors.initials: S
authors.lastname: Virabhak
authors.affiliation: Medicus Economics LLC, Milton, MA, USA.
authors.forename: Hélène
authors.initials: H
authors.lastname: Parisé
authors.affiliation: Medicus Economics LLC, Milton, MA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Health Economics and Outcomes Research, AbbVie, Inc., Mettawa, IL, USA. alice.wang@abbvie.com.
authors.forename: Alice
authors.initials: A
authors.lastname: Wang
authors.affiliation: Health Economics and Outcomes Research, AbbVie, Inc., Mettawa, IL, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Misurski
authors.affiliation: Health Economics and Outcomes Research, AbbVie, Inc., Mettawa, IL, USA.
authors.forename: Yuri Sanchez
authors.initials: YS
authors.lastname: Gonzalez
authors.affiliation: Health Economics and Outcomes Research, AbbVie, Inc., Mettawa, IL, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Juday
mesh_terms: D015081:2-Naphthylamine; D000328:Adult; 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 / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005449:Fluorenes / Q000191:economics / Q000627:therapeutic use; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology*; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D047029:Lactams, Macrocyclic; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology; D047028:Macrocyclic Compounds / Q000191:economics / Q000627:therapeutic use; D008390:Markov Chains; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D011392:Proline / Q000031:analogs & derivatives; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D019438:Ritonavir / Q000191:economics / Q000627:therapeutic use; D000069474:Sofosbuvir / Q000191:economics / Q000627:therapeutic use; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use; D014481:United States; 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; D016898:Interferon-alpha; D047029:Lactams, Macrocyclic; D047028:Macrocyclic Compounds; D011994:Recombinant Proteins; D013449:Sulfonamides; C586541:ledipasvir; C586094:ombitasvir; D011092:Polyethylene Glycols; D012254:Ribavirin; D014498:Uracil; D011392:Proline; D015081:2-Naphthylamine; C588260:dasabuvir; D014633:Valine; D019438:Ritonavir; C585405:paritaprevir; C100416:peginterferon alfa-2a; D000069474:Sofosbuvir
keywords: Cost-effectiveness; Direct-acting antivirals; Hepatitis C virus; Human immunodeficiency virus; Infectious diseases