Cost-effectiveness analysis of boceprevir for the treatment of chronic hepatitis C virus genotype 1 infection in Portugal

Elamin H. Elbasha, Jagpreet Chhatwal, Shannon A. Ferrante, Antoine C. El Khoury, Pedro A. Laires

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: The recent approval of two protease inhibitors, boceprevir and telaprevir, is likely to change the management of chronic hepatitis C virus (HCV) genotype 1 infection. Objectives: We evaluated the long-term clinical outcomes and the cost effectiveness of therapeutic strategies using boceprevir with peginterferon plus ribavirin (PR) in comparison with PR alone for treating HCV genotype 1 infection in Portugal. Methods: A Markov model was developed to project the expected lifetime costs and quality-adjusted life-years (QALYs) associated with PR alone and the treatment strategies outlined by the European Medicines Agency in the boceprevir summary of product characteristics. The boceprevir-based therapeutic strategies differ according to whether or not the patient was previously treated and whether or not the patient had compensated cirrhosis. The model simulated the experience of a series of cohorts of chronically HCV-infected patients (each defined by age, sex, race and fibrosis score). All treatment-related inputs were obtained from boceprevir clinical trials - SPRINT-2, RESPOND-2 and PROVIDE. Estimates of the natural history parameters and health state utilities were based on published studies. Portugal-specific annual direct costs of HCV health states were estimated by convening a panel of experts to derive health state resource use and multiplying the results by national unit costs. The model was developed from a healthcare system perspective with a timeframe corresponding to the remaining duration of the patients' lifetimes. Both future costs and QALYs were discounted at 5 %. To test the robustness of the conclusions, we conducted deterministic and probabilistic sensitivity analyses. Results: In comparison with the treatment with PR alone, boceprevir-based regimens were projected to reduce the lifetime incidence of advanced liver disease, liver transplantation, and liver-related death by 45-51 % and increase life expectancy by 2.3-4.3 years. Although the addition of BOC increased treatment costs by €13,300-€19,700, the reduction of disease burden resulted in a decrease of €5,400-€9,000 in discounted health state costs and an increase of 0.68-1.23 in discounted QALYs per patient. The incremental cost-effectiveness ratios of the boceprevir-based regimens compared with PR among previously untreated and previously treated patients were €11,600/QALY and €8,700/QALY, respectively. The results were most sensitive to variations in sustained virologic response rates, discount rates and age at treatment. Conclusions: Adding boceprevir to PR was projected to reduce the number of liver complications and liver-related deaths, and to be cost effective in treating both previously untreated and treated patients.

Original languageEnglish (US)
Pages (from-to)65-78
Number of pages14
JournalApplied Health Economics and Health Policy
Volume11
Issue number1
DOIs
StatePublished - Feb 1 2013

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Portugal
Chronic Hepatitis C
Hepacivirus
Cost-Benefit Analysis
Ribavirin
Genotype
Quality-Adjusted Life Years
Infection
Costs and Cost Analysis
Therapeutics
Health Care Costs
Liver
Fibrosis
N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide
Cost-effectiveness analysis
Hepatitis C
Virus
Health Resources
Health
Life Expectancy

ASJC Scopus subject areas

  • Economics and Econometrics
  • Health Policy

Cite this

Cost-effectiveness analysis of boceprevir for the treatment of chronic hepatitis C virus genotype 1 infection in Portugal. / Elbasha, Elamin H.; Chhatwal, Jagpreet; Ferrante, Shannon A.; El Khoury, Antoine C.; Laires, Pedro A.

In: Applied Health Economics and Health Policy, Vol. 11, No. 1, 01.02.2013, p. 65-78.

Research output: Contribution to journalArticle

Elbasha, Elamin H. ; Chhatwal, Jagpreet ; Ferrante, Shannon A. ; El Khoury, Antoine C. ; Laires, Pedro A. / Cost-effectiveness analysis of boceprevir for the treatment of chronic hepatitis C virus genotype 1 infection in Portugal. In: Applied Health Economics and Health Policy. 2013 ; Vol. 11, No. 1. pp. 65-78.
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