Cost-Effectiveness of Genotype 1 Chronic Hepatitis C Virus Treatments in Patients Coinfected with Human Immunodeficiency Virus in the United States. Issue 8 (August 2016)

• Record Type: Journal Article
• Authors: Saab, Sammy; Virabhak, Suchin; Parisé, Hélène; Johnson, Scott; Wang, Alice; Misurski, Derek; Gonzalez, Yuri; Juday, Timothy
• Is Part Of: Advances in therapy. Volume 33:Issue 8(2016)
• Page Start: 1316
• Page End: 1330
• Publication Date: 2016-08
• Subjects: Cost-effectiveness -- Direct-acting antivirals -- Hepatitis C virus -- Human immunodeficiency virus -- Infectious diseases; Diagnosis -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1007/s12325-016-0362-1
• Languages: English
• ISSNs: 0741-238X

Abstract

Abstract Introduction New treatments for chronic hepatitis C virus (HCV) are highly effective in patients coinfected with human immunodeficiency virus (HIV). This study estimated the cost-effectiveness of treatments for genotype 1 (GT1) HCV in HIV-coinfected patients. Methods A Markov model based on HCV natural history was used. The base-case analysis included both treatment-naïve and -experienced patients. Alternatives were ombitasvir/paritaprevir/ritonavir, dasabuvir with or without ribavirin (3D ± R) for 12 or 24 weeks, sofosbuvir plus peginterferon and R (SOF + PR) for 12 weeks, SOF + R for 24 weeks, and no treatment (NT). A subgroup analysis restricted to treatment-naïve, non-cirrhotic patients compared 3D ± R for 12 weeks to SOF plus ledipasvir (LDV) for 12 weeks and NT. Transition probabilities, utilities, and costs were obtained from the published literature. Outcomes were measured over a lifetime horizon and included rates of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver-related death, total costs, life-years, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results In the base-case, SOF + R was dominated by both SOF + PR and 3D ± R. Compared to SOF + PR, 3D ± R had an ICER of $45, 581. The lifetime rates of liver morbidity and mortality were lower among those treated with 3D ± R compared to SOF + PR, SOF + R, or NT. In the subgroup analysis, 3D ± R was cost-effective compared to NT at a threshold of $50, 000 per QALY (ICER $27, 496). SOF/LDV had an ICER of $104, 489 per QALY gained compared to 3D ± R. Conclusion In the GT1 HCV population coinfected with HIV, 3D ± R was cost-effective compared to NT, SOF + R, and SOF + PR. In the treatment-naïve sub-population, 3D ± R was cost-effective compared to NT and SOF/LDV.