A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic hepatitis C virus

Fawsitt, C. G. et al. (2019) A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic hepatitis C virus. Value in Health, 22(6), pp. 693-703. (doi: 10.1016/j.jval.2018.12.011) (PMID:31198187) (PMCID:PMC6588649)

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BACKGROUND:Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. OBJECTIVES:To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients. METHODS:Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies. RESULTS:The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course. CONCLUSIONS:Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Thomson, Professor Emma
Authors: Fawsitt, C. G., Vickerman, P., Cooke, G., Welton, N. J., Barnes, E., Ball, J., Brainard, D., Burgess, G., Cooke, G., 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 > Institute of Infection Immunity and Inflammation
Journal Name:Value in Health
ISSN (Online):1524-4733
Copyright Holders:Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research
First Published:First published in Value in Health 22(6):693-703
Publisher Policy:Reproduced under a Creative Commons licence

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