Cost-effectiveness of telaprevir in combination with pegylated interferon alpha and ribavirin in previously untreated chronic hepatitis C genotype 1 patients

• Published in: Journal of medical economics Vol. 17; no. 1; p. 65
• Main Authors: Cure, Sandrine, Bianic, Florence, Gavart, Sandra, Curtis, Steve, Lee, Seina, Dusheiko, Geoffrey
• Format: Journal Article
• Language: English
• Published: England 01.01.2014
• Subjects: Antiviral Agents - economics; Antiviral Agents - therapeutic use; Cost-Benefit Analysis; Drug Therapy, Combination; Health Resources - economics; Health Resources - utilization; Hepacivirus - drug effects; Hepatitis C, Chronic - drug therapy; Humans; Interferon-alpha - economics; Interferon-alpha - therapeutic use; Markov Chains; Oligopeptides - economics; Oligopeptides - therapeutic use; Polyethylene Glycols - economics; Polyethylene Glycols - therapeutic use; Recombinant Proteins - economics; Recombinant Proteins - therapeutic use; Ribavirin - economics; Ribavirin - therapeutic use; Survival Analysis
• ISSN: 1941-837X
• DOI: 10.3111/13696998.2013.860033

Telaprevir (T, TVR) is a direct-acting antiviral (DAA) used for the treatment of genotype 1 chronic hepatitis C virus (HCV) infection. The sustained virological response (SVR) rates, i.e., undetectable HCV RNA levels 24 weeks after the end of treatment, is what differentiate treatments. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV), with Peg-IFN and RBV (PR) alone or with boceprevir (B, BOC) plus Peg-IFN alfa-2b and RBV, in naïve patients. A Markov cohort model of chronic HCV disease progression reflected the pathway of naïve patients initiating anti-HCV therapy. SVR rates were derived from a mixed-treatment comparison including results from Phase II and III trials of TVR and BOC, and trials comparing both PR regimens. SVR has significant impact on survival, quality-of-life, and costs. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the (National Health Service) NHS perspective. Cost and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were also performed by interleukin (IL)-28B genotype and fibrosis stage. Higher costs and improved outcomes were associated with T/PR relative to PR alone, resulting in an ICER of £12,733 per QALY gained. T/PR retained a significant SVR advantage over PR alone and was cost-effective regardless of IL-28B genotype and fibrosis stages. T/PR regimen 'dominated' B/PR, generating 0.2 additional QALYs and reducing lifetime cost by £2758. Sensitivity analyses consistently resulted in ICERs less than £30,000/QALY for the T/PR regimen over PR alone. No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR. The introduction of TVR-based therapy for genotype 1 HCV patients is cost-effective for naïve patients at the £30,000 willingness-to-pay threshold, regardless of IL-28B genotype or fibrosis stage.