COST EFFECTIVENESS OF DACLATASVIR/ASUNAPREVIR VERSUS PEGINTERFERON/RIBAVIRIN AND PROTEASE INHIBITORS FOR THE TREATMENT OF HEPATITIS C GENOTYPE 1B IN CHILE
Author(s)
Vargas C1, Espinoza MA1, Giglio A2, Soza A3
1Pontificia Universidad Catolica de Chile, Santiago, Chile, 2Complejo Asistencial Sótero del Río, Santiago, Chile, 3Pontificia Universidad Católica de Chile, Santiago, Chile
OBJECTIVES: To assess the cost-effectiveness of daclatasvir plus asunaprevir (DCV/ASV) versus peginterferon plus ribavirin (PR) and first generation protease inhibitors (PIs) for the treatment of patients with hepatitis C genotype 1b, from the perspective of the Chilean public healthcare system. METHODS: A Markov cohort model (MONARCH) was built to estimate the expected costs in Chilean pesos (CL$) and benefits in quality adjusted life years (QALYs) from aggregated data. Efficacy was obtained from a mixed-treatment comparison study and costs were estimated from local sources. Utilities were estimated from the literature. A time horizon of 46 years and a 3% discount rate was considered for costs and outcomes. Three groups of patients were examined: untreated (naïve), partial responders and non-responders. The ICER in naive patients is presented for a range of DCV/ASV prices. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: PIs were extendedly dominated by DCV/ASV. In naïve patients the ICER of DCV/ASV compared to PR was CL$ 15,696,479/QALY (US$26,160/QALY) at a treatment price of CL$48,000,000 (US$79,200); CL$10,751,318/QALY (US$17,918/QALY) at a price of CL$36,000,000 (US$60,000); CL$5,950,954/QALY (US$9,918/QALY) at a price of CL$24,000,000 (US$40,000); and CL$1,278,270/QALY (US$2,130/QALY) at a price of CL$12,000,000 (US$20,000). Whilst the probability of cost-effectiveness at a price of CL$36,000,000 was 59%, there is a 45% probability that DCV/ASV dominates PR if the price was CL$12,000,000. The ICER for partial responders was CL$6,082,698/QALY (US$10,137/QALY) and for non-responders CL$6,603,023/QALY (US$11,005/QALY) at a DCV/ASV price of CL$36,000,000. The ICER was more sensitive to the discount rate, efficacy of DCV/ASV and the utility of the sustained viral response state in cirrhotic patients CONCLUSIONS: DCV/ASV can be considered cost-effective at some particular price range. These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system.
Conference/Value in Health Info
2015-05, ISPOR 2015, Philadelphia, PA, USA
Value in Health, Vol. 18, No. 3 (May 2015)
Code
PGI23
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Gastrointestinal Disorders, Infectious Disease (non-vaccine)