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Cost-effectiveness of Telaprevir Combination Therapy for Chronic Hepatitis C

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  • Anita J Brogan
  • Sandra E Talbird
  • James R Thompson
  • Jeffrey D Miller
  • Jaime Rubin
  • Baris Deniz

Abstract

Objective: To explore the expected long-term health and economic outcomes of telaprevir (TVR) plus peginterferon alfa-2a and ribavirin (PR), a regimen that demonstrated substantially increased sustained virologic response (SVR) compared with PR alone in adults with chronic genotype 1 hepatitis C virus (HCV) and compensated liver disease in the Phase III studies ADVANCE (treatment-naïve patients) and REALIZE (relapsers, partial responders, and null responders to previous PR treatment). Study Design: A decision-analytic model was developed to assess the cost-effectiveness of TVR+PR vs. PR in the United States (US). Methods: Patients first moved through the 72-week decision-tree treatment phase of the model and then entered the cyclic Markov post-treatment phase. Clinical data (patient characteristics, SVR rates, and adverse event rates and durations) were obtained from ADVANCE and REALIZE. Health-state transition probabilities, drug and other costs (in 2012/2013 US dollars), and utility values were obtained from the trials, published studies, and publicly available sources. Outcomes were discounted at 3% per year. Results: Regardless of treatment history, patients receiving TVR+PR were projected to experience fewer liver-disease complications, more life-years, and more quality-adjusted life-years (QALYs) than patients receiving PR. In prior relapsers, TVR+PR was dominant, with lower total medical costs and more QALYs. For the other patient subgroups, incremental costs per QALY gained were between $16,778 (treatment-naïve patients) and $34,279 (prior null responders). Extensive sensitivity analyses confirmed robust model results. Conclusions: At standard willingness-to-pay thresholds, TVR+PR represents a cost-effective treatment option compared with PR alone for patients with chronic genotype 1 HCV and compensated liver disease in the US. Future analyses are needed to compare TVR+PR with all existing HCV treatment options.

Suggested Citation

  • Anita J Brogan & Sandra E Talbird & James R Thompson & Jeffrey D Miller & Jaime Rubin & Baris Deniz, 2014. "Cost-effectiveness of Telaprevir Combination Therapy for Chronic Hepatitis C," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-11, March.
    • Handle: RePEc:plo:pone00:0090295
    DOI: 10.1371/journal.pone.0090295
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    References listed on IDEAS

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    1. Wong, J.B. & McQuillan, G.M. & McHutchison, J.G. & Poynard, T., 2000. "Estimating future hepatitis C morbidity, mortality, and costs in the United States," American Journal of Public Health, American Public Health Association, vol. 90(10), pages 1562-1569.
    2. Shan Liu & Michaël Schwarzinger & Fabrice Carrat & Jeremy D Goldhaber-Fiebert, 2011. "Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients," PLOS ONE, Public Library of Science, vol. 6(12), pages 1-14, December.
    3. D. Spackman & David Veenstra, 2008. "A Cost-Effectiveness Analysis of Currently Approved Treatments for HBeAg-Positive Chronic Hepatitis B," PharmacoEconomics, Springer, vol. 26(11), pages 937-949, November.
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    1. Aikaterini Vellopoulou & Michel Agthoven & Annemarie Kolk & Robert Knegt & Gilles Berdeaux & Sandrine Cure & Florence Bianic & Mark Lamotte, 2014. "Cost Utility of Telaprevir–PR (Peginterferon–Ribavirin) Versus Boceprevir–PR and Versus PR Alone in Chronic Hepatitis C in The Netherlands," Applied Health Economics and Health Policy, Springer, vol. 12(6), pages 647-659, December.
    2. Louis Matza & Sandhya Sapra & John Dillon & Anupama Kalsekar & Evan Davies & Mary Devine & Jessica Jordan & Amanda Landrian & David Feeny, 2015. "Health state utilities associated with attributes of treatments for hepatitis C," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(9), pages 1005-1018, December.

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