Cost-effectiveness analysis of baseline testing for resistance-associated polymorphisms to optimize treatment outcome in genotype 1 noncirrhotic treatment-naïve patients with chronic hepatitis C virus

Fawsitt, C. G. et al. (2020) Cost-effectiveness analysis of baseline testing for resistance-associated polymorphisms to optimize treatment outcome in genotype 1 noncirrhotic treatment-naïve patients with chronic hepatitis C virus. Value in Health, 23(2), pp. 180-190. (doi: 10.1016/j.jval.2019.08.012) (PMID:32113623) (PMCID:PMC7057278)

Abstract

OBJECTIVES:Direct-acting antivirals containing nonstructural protein 5A (NS5A) inhibitors administered over 8 to 12 weeks are effective in ∼95% of patients with hepatitis C virus. Nevertheless, patients resistant to NS5A inhibitors have lower cure rates over 8 weeks (<85%); for these patients, 12 weeks of treatment produces cure rates greater than 95%. We evaluated the lifetime cost-effectiveness of testing for NS5A resistance at baseline and optimizing treatment duration accordingly in genotype 1 noncirrhotic treatment-naïve patients from the perspective of the UK National Health Service. METHODS:A decision-analytic model compared (1) standard 12-week treatment (no testing), (2) shortened 8-week treatment (no testing), and (3) baseline testing with 12-/8-week treatment for those with/without NS5A polymorphisms. Patients who failed first-line therapy were retreated for 12 weeks. Model inputs were derived from published studies. Costs, quality-adjusted life-years, and the probability of cost-effectiveness were calculated. RESULTS:Baseline testing had an incremental net monetary benefit (INMB) of £11 838 versus standard 12 weeks of therapy (no testing) and low probability (31%) of being the most cost-effective, assuming £30 000 willingness to pay. Shortened 8 weeks of treatment (no testing) had an INMB of £12 294 and the highest probability (69%) of being most cost-effective. Scenario analyses showed baseline testing generally had the highest INMB and probability of being most cost-effective if first- and second-line drug prices were low (<£20k). CONCLUSIONS:Optimizing treatment duration based on NS5A polymorphisms for genotype 1 noncirrhotic treatment-naive patients in the United Kingdom is not cost-effective if the drug costs are high; the strategy is generally most cost-effective when drug prices are low (<£20k).

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Thomson, Professor Emma
• Authors: Fawsitt, C. G., Vickerman, P., Cooke, G. S., Welton, N. J., Barnes, E., Ball, J., Brainard, D., Burgess, G., Cooke, G. S., Dillon, J., Foster, G., Gore, C., Guha, N., Halford, R., Whitby, K., Holmes, C., Howe, A., Hudson, E., Hutchinson, S., Irving, W., Khakoo, S., Klenerman, P., Martin, N., Massetto, B., Mbisa, T., McHutchison, J., McKeating, J., McLauchlan, J., Miners, A., Murray, A., Shaw, P., Simmonds, P., Spencer, C., Thomson, E., Vickerman, P., and Zitzmann, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Virus Research
• Journal Name: Value in Health
• Publisher: Elsevier
• ISSN: 1098-3015
• ISSN (Online): 1524-4733
• Published Online: 24 October 2019
• Copyright Holders: Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research
• First Published: First published in Value in Health 23(2):180-190
• Publisher Policy: Reproduced under a Creative Commons licence