Cost-effectiveness of boceprevir or telaprevir for previously treated patients with genotype 1 chronic hepatitis C
Cost-effectiveness of boceprevir or telaprevir for previously treated patients with genotype 1 chronic hepatitis C
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DOI：
10.1016/j.jhep.2013.05.019
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发表时间：
2013-10-01
影响因子：
25.7
通讯作者：
Craxi, Antonio
中科院分区：
文献类型：
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作者：
Camma, Calogero;Petta, Salvatore;Craxi, Antonio
背景与目的：随机对照试验（RCTs）显示，在治疗既往复发（RR）、部分缓解（PAR）和无缓解（NR）的基因1型（G1）慢性丙型肝炎（CHC）患者时，聚乙二醇干扰素、利巴韦林和博昔韦（BOC）或替拉韦（TVR）三联治疗（TT）比聚乙二醇干扰素-利巴韦林双重治疗（DT）更有效。我们评估了TT治疗与不治疗相比在既往G1 CHC患者治疗中的成本效益。方法：以现有已发表的文献为资料来源。目标人群由先前治疗过的G1 CHC高加索患者组成，并通过马尔可夫模型对这些患者进行终身评估。这项研究是从意大利国家卫生局的角度进行的。结果包括贴现成本（以2012年欧元价值计算）、获得的生命年（LYG）、质量调整生命年（QALY）和增量成本效益比（ICER）。结果的稳健性通过单向确定性和多变量概率敏感性分析进行评估。结果：在RR患者中，与未治疗相比，每LYG对BOC- lead - In -RR的ICER为epsilon 9555，对TVR- lead - In -RR的ICER为epsilon 7910，以TVR为主。在PAR患者中，对于BOC-铅- In -PAR， LYG的ICER为epsilon 11,947，对于TVR-PAR， ICER为epsilon 14,931，与BOC相比，TVR具有成本效益（QALY的ICER为epsilon 22258）。在NR患者中，TVR-LEAD-IN-NR的LYG ICER为epsilon 26,499。该模型对持续病毒学的可能性敏感。结论：第一代HCV PI在RR和PAR G1 CHC患者中与不治疗相比具有很高的成本效益。TVR在RR患者中主导BOC，并且与PAR患者中的BOC相比具有成本效益。在NR患者中，应在引入期后对反应进行评估，以提高安全性和成本效益。(C) 2013欧洲肝脏研究协会。Elsevier b.v.版权所有。
Background & Aims: Randomised controlled trials (RCTs) show that triple therapy (TT) with peginterferon alfa, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of genotype 1 (G1) chronic hepatitis C (CHC) patients with previous relapse (RR), partial response (PAR), and null-response (NR). We assess the cost-effectiveness of TT compared to no therapy in the treatment of patients previously treated with G1 CHC.Methods: The available published literature provided the data source. The target population was made up of previously treated Caucasian patients with G1 CHC and these were evaluated over a lifetime horizon by Markov model. The study was carried out from the perspective of the Italian National Health Service. Outcomes included discounted costs (in euro at 2012 value), life years gained (LYG), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER). The robustness of theresults was evaluated by one-way deterministic and multivariable probabilistic sensitivity analyses. Results: In RR patients, ICER per LYG compared to no therapy was epsilon 9555 for BOC-LEAD-IN-RR and epsilon 7910 for TVR-LEAD-IN-RR, being BOC dominated by TVR. In PAR patients, ICER for LYG was epsilon 11,947 for BOC-LEAD-IN-PAR and epsilon 14,931 for TVR-PAR, being TVR cost-effective compared to BOC (ICER for QALY epsilon 22,258). In NR patients, ICER for LYG was epsilon 26,499 for TVR-LEAD-IN-NR. The models were sensitive to likelihood of sustained virologicalConclusions: 1st generation HCV PI is highly cost-effective compared to no therapy in RR and PAR G1 CHC patients. TVR dominated BOC in RR, and was cost-effective compared to BOC in PAR patients. In NR patients an assessment of the response after a lead-in period should be performed to improve safety and costeffectiveness. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.