SOFOSBUVIR FOR THE TREATMENT OF CHRONIC HEPATITIS C- A COMPREHENSIVE COST-EFFECTIVENESS ANALYSIS ACROSS HCV GENOTYPES, PRETREATMENT CONDITIONS AND HIV CO-INFECTION
Author(s)
Silva M1, Félix J1, Ferreira D1, Vandewalle B1, Guerra I2, Cure S2, Aldir I3, Carvalho A4, Macedo G5, Marinho RT6, Pedroto I7, Ramalho F6
1Exigo Consultores, Alhos Vedros, Portugal, 2OptumInsight, Uxbridge, UK, 3Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal, 4Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 5Hospital de São João, Porto, Portugal, 6Centro Hospitalar Lisboa Norte. Hospital de Santa Maria, Lisboa, Portugal, 7Centro Hospitalar do Porto, Porto, Portugal
OBJECTIVES Pegylated interferon-α plus ribavirin (PR) has been the standard of care for Chronic Hepatitis C (CHC). Therapy adding boceprevir (BOC) or telaprevir (TVR) to PR in HCV genotype-1 patients has failed to achieve generalized market acceptance, in part due to the approval of newer more efficacious and safer options like sofosbuvir (SOF), a new pan-genotypic RNA-polymerase inhibitor. Objective: To assess the cost-effectiveness of sofosbuvir based therapy for CHC across HCV genotypes, pretreatment conditions and HIV co-infection in Portugal. METHODS Costs and effectiveness were estimated based on discrete-time Markov-type model for CHC evolution accounting for different subpopulations in terms of HCV genotype, fibrosis progression, HIV co-infection status and previous treatment experience. The model incorporates 13 health states: 5 Metavir score, 2 SVR (with and without cirrhosis) and 3 advanced liver disease states (decompensated cirrhosis, hepatocellular carcinoma, liver transplant). Results are expressed in incremental costs per life year (LY) and quality-adjusted life year (QALY). RESULTS Overall sofosbuvir-containing regimens are expected to result in an increment of 3.49 LY (3.05 QALY) after weighting for the different subpopulations assuming Portuguese epidemiology. The corresponding weighted incremental cost-effectiveness ratios (ICER) was 14,649€/LY (16,720€/QALY). In the comparison against the BOC and TVR containing regimens (genotype-1), ICER of 10,675€/LY (12,238€/QALY) and 14,618€/LY (16,495€/QALY) were obtained, respectively. For HIV co-infected and PegIFN eligible/tolerant patients, estimated ICER varied between 6,463€/LY (6,902€/QALY) and 21,281€/LY (28,245€/QALY), for G1 and G2, respectively, when comparing against treatment with PR. Additionally, in HCV/HIV coinfected patients ineligible/intolerant to PegIFN, the comparison against lack-of-therapy resulted in ICER of 15,656€/LY (17,756€/QALY) and 12,915€/LY (19,077€/QALY), for HCV G1 and G3, respectively. CONCLUSIONS Sofosbuvir-containing regimens for the treatment of adult CHC patients, irrespective of HIV co-infection status, are expected to result in significant health gains at an incremental cost within the range of European Health Authorities acceptability.
Conference/Value in Health Info
2014-11, ISPOR Europe 2014, Amsterdam, The Netherlands
Value in Health, Vol. 17, No. 7 (November 2014)
Code
PGI23
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Gastrointestinal Disorders, Infectious Disease (non-vaccine)