Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response

Ziad F Gellad, Andrew J Muir, John G McHutchison, William Sievert, Ala I Sharara, Kimberly A Brown, Robert Flisiak, Ira M Jacobson, David Kershenobich, Michael P Manns, Kevin Schulman, Shelby D Reed

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Abstract

BACKGROUND: Shortened courses of treatment with pegylated interferon alfa and ribavirin for patients with hepatitis C virus infection who experience rapid virologic response can be effective in appropriately selected patients. The cost-effectiveness of truncated therapy is not known. OBJECTIVE: To assess the cost-effectiveness of response-guided therapy versus standard-duration therapy on the basis of best available evidence. METHODS: We developed a decision model for chronic hepatitis C virus infection representing two treatment strategies: 1) standard-duration therapy with pegylated interferon alfa and ribavirin for 48 weeks in patients with genotype 1 or 4 and for 24 weeks in patients with genotype 2 or 3 and 2) truncated therapy (i.e., 50 decrease in treatment duration) in patients with rapid virologic response. Patients for whom truncated therapy failed began standard-duration therapy guided by genotype. We used a Markov model to estimate lifetime costs and quality-adjusted life-years. RESULTS: In the base-case analysis, mean lifetime costs were 46,623 +/- 2,483 with standard-duration therapy and 42,354 +/- 2,489 with truncated therapy. Mean lifetime quality-adjusted life-years were similar between the groups (17.1 +/- 0.7 with standard therapy; 17.2 +/- 0.7 with truncated therapy). Across model simulations, the probability of truncated therapy being economically dominant (i.e., both cost saving and more effective) was 78.6 . The results were consistent when we stratified the data by genotype. In one-way sensitivity analyses, the results were sensitive only to changes in treatment efficacy. CONCLUSION: Truncated therapy based on rapid virologic response is likely to be cost saving for treatment-naive patients with chronic hepatitis C virus infection. Cost-effectiveness varied with small changes in relative treatment efficacy.
Original languageEnglish
Pages (from-to)876 - 886
Number of pages11
JournalValue in Health
Volume15
Issue number6
DOIs
Publication statusPublished - 2012

Cite this

Gellad, Z. F., Muir, A. J., McHutchison, J. G., Sievert, W., Sharara, A. I., Brown, K. A., ... Reed, S. D. (2012). Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response. Value in Health, 15(6), 876 - 886. https://doi.org/10.1016/j.jval.2012.06.010
Gellad, Ziad F ; Muir, Andrew J ; McHutchison, John G ; Sievert, William ; Sharara, Ala I ; Brown, Kimberly A ; Flisiak, Robert ; Jacobson, Ira M ; Kershenobich, David ; Manns, Michael P ; Schulman, Kevin ; Reed, Shelby D. / Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response. In: Value in Health. 2012 ; Vol. 15, No. 6. pp. 876 - 886.
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title = "Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response",
abstract = "BACKGROUND: Shortened courses of treatment with pegylated interferon alfa and ribavirin for patients with hepatitis C virus infection who experience rapid virologic response can be effective in appropriately selected patients. The cost-effectiveness of truncated therapy is not known. OBJECTIVE: To assess the cost-effectiveness of response-guided therapy versus standard-duration therapy on the basis of best available evidence. METHODS: We developed a decision model for chronic hepatitis C virus infection representing two treatment strategies: 1) standard-duration therapy with pegylated interferon alfa and ribavirin for 48 weeks in patients with genotype 1 or 4 and for 24 weeks in patients with genotype 2 or 3 and 2) truncated therapy (i.e., 50 decrease in treatment duration) in patients with rapid virologic response. Patients for whom truncated therapy failed began standard-duration therapy guided by genotype. We used a Markov model to estimate lifetime costs and quality-adjusted life-years. RESULTS: In the base-case analysis, mean lifetime costs were 46,623 +/- 2,483 with standard-duration therapy and 42,354 +/- 2,489 with truncated therapy. Mean lifetime quality-adjusted life-years were similar between the groups (17.1 +/- 0.7 with standard therapy; 17.2 +/- 0.7 with truncated therapy). Across model simulations, the probability of truncated therapy being economically dominant (i.e., both cost saving and more effective) was 78.6 . The results were consistent when we stratified the data by genotype. In one-way sensitivity analyses, the results were sensitive only to changes in treatment efficacy. CONCLUSION: Truncated therapy based on rapid virologic response is likely to be cost saving for treatment-naive patients with chronic hepatitis C virus infection. Cost-effectiveness varied with small changes in relative treatment efficacy.",
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Gellad, ZF, Muir, AJ, McHutchison, JG, Sievert, W, Sharara, AI, Brown, KA, Flisiak, R, Jacobson, IM, Kershenobich, D, Manns, MP, Schulman, K & Reed, SD 2012, 'Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response', Value in Health, vol. 15, no. 6, pp. 876 - 886. https://doi.org/10.1016/j.jval.2012.06.010

Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response. / Gellad, Ziad F; Muir, Andrew J; McHutchison, John G; Sievert, William; Sharara, Ala I; Brown, Kimberly A; Flisiak, Robert; Jacobson, Ira M; Kershenobich, David; Manns, Michael P; Schulman, Kevin; Reed, Shelby D.

In: Value in Health, Vol. 15, No. 6, 2012, p. 876 - 886.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response

AU - Gellad, Ziad F

AU - Muir, Andrew J

AU - McHutchison, John G

AU - Sievert, William

AU - Sharara, Ala I

AU - Brown, Kimberly A

AU - Flisiak, Robert

AU - Jacobson, Ira M

AU - Kershenobich, David

AU - Manns, Michael P

AU - Schulman, Kevin

AU - Reed, Shelby D

PY - 2012

Y1 - 2012

N2 - BACKGROUND: Shortened courses of treatment with pegylated interferon alfa and ribavirin for patients with hepatitis C virus infection who experience rapid virologic response can be effective in appropriately selected patients. The cost-effectiveness of truncated therapy is not known. OBJECTIVE: To assess the cost-effectiveness of response-guided therapy versus standard-duration therapy on the basis of best available evidence. METHODS: We developed a decision model for chronic hepatitis C virus infection representing two treatment strategies: 1) standard-duration therapy with pegylated interferon alfa and ribavirin for 48 weeks in patients with genotype 1 or 4 and for 24 weeks in patients with genotype 2 or 3 and 2) truncated therapy (i.e., 50 decrease in treatment duration) in patients with rapid virologic response. Patients for whom truncated therapy failed began standard-duration therapy guided by genotype. We used a Markov model to estimate lifetime costs and quality-adjusted life-years. RESULTS: In the base-case analysis, mean lifetime costs were 46,623 +/- 2,483 with standard-duration therapy and 42,354 +/- 2,489 with truncated therapy. Mean lifetime quality-adjusted life-years were similar between the groups (17.1 +/- 0.7 with standard therapy; 17.2 +/- 0.7 with truncated therapy). Across model simulations, the probability of truncated therapy being economically dominant (i.e., both cost saving and more effective) was 78.6 . The results were consistent when we stratified the data by genotype. In one-way sensitivity analyses, the results were sensitive only to changes in treatment efficacy. CONCLUSION: Truncated therapy based on rapid virologic response is likely to be cost saving for treatment-naive patients with chronic hepatitis C virus infection. Cost-effectiveness varied with small changes in relative treatment efficacy.

AB - BACKGROUND: Shortened courses of treatment with pegylated interferon alfa and ribavirin for patients with hepatitis C virus infection who experience rapid virologic response can be effective in appropriately selected patients. The cost-effectiveness of truncated therapy is not known. OBJECTIVE: To assess the cost-effectiveness of response-guided therapy versus standard-duration therapy on the basis of best available evidence. METHODS: We developed a decision model for chronic hepatitis C virus infection representing two treatment strategies: 1) standard-duration therapy with pegylated interferon alfa and ribavirin for 48 weeks in patients with genotype 1 or 4 and for 24 weeks in patients with genotype 2 or 3 and 2) truncated therapy (i.e., 50 decrease in treatment duration) in patients with rapid virologic response. Patients for whom truncated therapy failed began standard-duration therapy guided by genotype. We used a Markov model to estimate lifetime costs and quality-adjusted life-years. RESULTS: In the base-case analysis, mean lifetime costs were 46,623 +/- 2,483 with standard-duration therapy and 42,354 +/- 2,489 with truncated therapy. Mean lifetime quality-adjusted life-years were similar between the groups (17.1 +/- 0.7 with standard therapy; 17.2 +/- 0.7 with truncated therapy). Across model simulations, the probability of truncated therapy being economically dominant (i.e., both cost saving and more effective) was 78.6 . The results were consistent when we stratified the data by genotype. In one-way sensitivity analyses, the results were sensitive only to changes in treatment efficacy. CONCLUSION: Truncated therapy based on rapid virologic response is likely to be cost saving for treatment-naive patients with chronic hepatitis C virus infection. Cost-effectiveness varied with small changes in relative treatment efficacy.

UR - http://www.ncbi.nlm.nih.gov/pubmed/22999138

U2 - 10.1016/j.jval.2012.06.010

DO - 10.1016/j.jval.2012.06.010

M3 - Article

VL - 15

SP - 876

EP - 886

JO - Value in Health

JF - Value in Health

SN - 1098-3015

IS - 6

ER -