title: Value of Sustained Virologic Response in Patients with Hepatitis C as a Function of Time to Progression of End-Stage Liver Disease.
abstract: BACKGROUND
  Targeted intervention in patients with hepatitis C virus (HCV) closest to end-stage liver disease (ESLD) progression may offer an approach to treatment prioritisation whilst delivering benefits for patients and the healthcare system. In contrast to previous HCV economic analyses, this study aimed to estimate the health economic value of sustained virologic response (SVR) stratified by the patient's propensity to progress to ESLD.
  
  
  METHODS
  An HCV natural history model was adapted to estimate the value of avoiding ESLD complications following SVR, assessed as cost offsets and quality-adjusted life year (QALY) gains, as a function of time to ESLD at treatment initiation. These outcomes were used to estimate the financial value of achieving SVR, defined as the maximum investment that could be allocated without exceeding a willingness-to-pay threshold of £20,000/QALY.
  
  
  RESULTS
  Regardless of time to ESLD onset, achieving SVR was beneficial, resulting in cost offsets and QALY gains, due to avoidance of ESLD complications. The value of achieving SVR was greatest in patients closest to ESLD onset, resulting in increased cost offsets and QALY gains (up to £50,901 and 9.56 QALYs). In patients closest to ESLD onset, the financial value of achieving SVR was £242,051, compared with £127,116 in patients furthest from onset.
  
  
  CONCLUSIONS
  Standard cost-effectiveness evaluations may underestimate the value of treatment in HCV patients closest to ESLD development. Targeted intervention would promote efficient allocation of limited healthcare resources and reconcile concerns surrounding the affordability of new direct-acting antivirals, by minimising the number-needed-to-treat to maximise health benefit, whilst minimising healthcare expenditure.
authors: HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK. tom.ward@heor.co.uk.
authors: Thomas
authors: T
authors: Ward
authors: HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK.|Department of Public Health, University of Adelaide, Adelaide, Australia.
authors: Jason
authors: J
authors: Gordon
authors: HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK.
authors: Beverley
authors: B
authors: Jones
authors: HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK.
authors: Hayley
authors: H
authors: Bennett
authors: HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK.
authors: Samantha
authors: S
authors: Webster
authors: World Wide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, USA.
authors: Anupama
authors: A
authors: Kalsekar
authors: World Wide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, USA.
authors: Yong
authors: Y
authors: Yuan
authors: UK HEOR, Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK.
authors: Michael
authors: M
authors: Brenner
authors: HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK.|School of Human and Health Sciences, Swansea University, Swansea, UK.
authors: Phil
authors: P
authors: McEwan
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000209:etiology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D000072230:Sustained Virologic Response; D013997:Time Factors
chemical_list: D000998:Antiviral Agents