Management of Chronic hepatitis C (CHC) Genotype 1 treatment-naive patients in an era of rising opportunities and costs - A cost-effectiveness analysis of treatment options

Background and Aims: To allocate treatment resources for CHC G1 patients, we performed a cost-effectiveness analysis of Boceprevir (BOC) and Telaprevir (TVR) based triple therapy according to different patient selection strategies. Methods: A semi-Markov model of CHC natural history and progression toward end stage liver diseases (decompensated cirrhosis, HCC and liver transplantation) was built. Model health states were defined by METAVIR fibrosis stages (F0–F4), and complications of cirrhosis. We considered 3 selection strategies based on fibrosis stage: 1) treat all patients with F1–F4 fibrosis, 2) only F2–F4 and 3) only F3–F4. For each strategy, TVR IL28B-guided and BOC RVR-guided therapy was applied. The model assessed the costs and outcomes, including QALYs, Life Years and the number of End Stage Liver Diseases developed or Death (ESLD-D), using lifetime as time horizon and adopting the NHS perspective. An alternative simulation was performed using 5 year as time horizon. Results: The F3–F4 selection strategy was the least expensive and the least effective. Adopting the lifetime horizon, F1–F4 strategy was cost-effective with an ICER of €5,132.13 for QALY, in TVR IL28Bguided, and €7,042.49 for QALY, in BOC RVR-guided therapy. In the 5 year scenario, the F1–F4 strategy was not cost-effective with an ICER of €1,818,679 (TVR IL-28B-guided) and €1,866.437 (BOC RVR-guided) for each ESLD-D avoided. Conclusions: Our model demonstrated the impact of patient selection strategies, and lifetime versus 5 year time horizons, on cost-effectiveness of HCV therapy, and its implications for the evaluation of cost utility of future interferon-containing and interferon-free regimens.