Effectiveness and Cost-Effectiveness of Triple Therapy With Telaprevir and Boceprevir for Chronic Hepatitis C: A Decision Analysis from The Perspective of The Brazilian Public Health System

• Published in: Value in health Vol. 20; no. 9; p. A883
• Main Authors: Borba, HH, Rochau, U, Wiens, A, Sroczynski, G, Siebert, U, Pontarolo, R
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01-10-2017
• Subjects: Analysis; Antiviral drugs; Chronic illnesses; Clinical outcomes; Cost analysis; Data processing; Decision analysis; Genotypes; Health care expenditures; Hepatitis; Hepatitis C; Life expectancy; Life span; Medical treatment; Public health; Quality adjusted life years; Quality of life; Ribavirin; Sensitivity analysis; Willingness to pay; United States > US
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.2627

OBJECTIVES: To perform a cost-effectiveness analysis comparing the regimens peginterferon plus ribavirin (peglFN/RBV), boceprevir (BOC) plus peglFN/RBV, tel-aprevir (TVR) plus peglFN/RBV, and no treatment for chronic hepatitis C (CHC) adopting the perspective of the Brazilian public health system. METHODS: A state-transition Markov model was developed simulating the progression of CHC in patients infected with hepatitis C virus genotype l.The long-term outcomes included remaining life expectancy in life years (LYs), quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Progression rates, quality of life data and sustained virological response rates (SVR) were based on published literature. Direct medical cost data were obtained from Brazilian databases. A lifelong time horizon was considered, and a 5% annual discount rate was applied for costs and clinical outcomes. A willingness-to-pay threshold of approximately US$ 20,000 per QALY was used. Multiple sensitivity analyses were performed. RESULTS: For both short- and long-term scenarios, the BOC+peglFN/ RBV was dominated byTVR+peglFN/RBV, which was more effective than peglFN/ RBV (75.0% vs. 40.4% SVR rate, 13.79 vs. 13.19 LYs and 10.42 vs. 9.40 QALYs, respectively), and was also more expensive (US$ 14,481.98 vs. US$ 4858.61). The corresponding ICERs were US$ 27,813.21/SVR, US$ 16,163/LY, and US$ 9,482/QALY for TVR+peglFN/RBV compared to peglFN/RBV. CONCLUSIONS: Based on our analysis, triple therapy with telaprevir is more effective than the other evaluated regimens and can be considered cost-effective for the Brazilian health system. Despite a lack of some Brazilian data, we incorporated as many applicable parameters as possible, and this model should be suitable for further cost-effectiveness analyses, when new data are available.