Background and aim: A relevant proportion of patients affected by chronic hepatitis C (CHC) is older than 65 years. Comorbidities and a higher susceptibility to drugs toxicity have historically limited treatment in these patients. Recent approval of interferon-free regimens, characterized by high efficacy and limited toxicity, provides unprecedented chances for these patients to be cured. The aim of this study is to assess cost-effectiveness, taking into account the severity of liver disease, age, and the geriatric (frailty) status. Methods: A semi-Markov model of CHC natural history was built. The study focuses on CHC patients older than 65 years, stratified according to liver fibrosis (METAVIR F3 and F4), age (65–85 years old) and Fried’s frailty phenotype (not frail, pre-frail and frail) generating 30 simulated cohorts. Treatment with sofosbuvir plus simeprevir (SOF/SMV) versus no treatment was assessed for each cohort. The model estimated costs, Life Years and Quality Adjusted Life Years (QALY), with a lifetime time horizon and the Health System perspective. Results are presented as incremental costeffectiveness ratios (ICERs) per QALY gained. Cost-effectiveness was defined as an ICER under the 37,000D threshold. Results: At each fibrosis score, ICER increased with age and frailty index. Among F3 patients, ICER ranged from D13,934 in notfrail 65-years-old andD79,354 in frail 85-years-old patients. Among F4 patients ICER ranged from D13,873 in not frail 65-years-old and D115,965 in frail 85-years-old patients. In both F3 and F4 cohorts ICER was below D37,000/QALY up to age 80 in non-frail patients, up to age 75 in pre-frail patients, up to age 70 in frail patients. Conclusion: SOF/SMV treatment is cost-effective in most CHC patients older than 65 years, however a careful assessment of the patient geriatric status is mandatory. This cost-effectiveness analysis should promote a prospective clinical study to verify efficacy and side effects in elderly HCV patients.
Ciaccio, A., Cortesi, P., Bellelli, G., Rota, M., Okolicsanyi, S., Rota, M., et al. (2015). Sofosbuvir-based all-oral treatment for elderly chronic hepatitis C patients: A cost-effectiveness analysis. DIGESTIVE AND LIVER DISEASE, 47(Suppl 1), E15-E16 [10.1016/j.dld.2015.01.036].
Sofosbuvir-based all-oral treatment for elderly chronic hepatitis C patients: A cost-effectiveness analysis
CIACCIO, ANTONIOPrimo
;CORTESI, PAOLO ANGELOSecondo
;BELLELLI, GIUSEPPE;ROTA, MATTEO;OKOLICSANYI, STEFANO;MANTOVANI, LORENZO GIOVANNI;ANNONI, GIORGIOPenultimo
;STRAZZABOSCO, MARIOUltimo
2015
Abstract
Background and aim: A relevant proportion of patients affected by chronic hepatitis C (CHC) is older than 65 years. Comorbidities and a higher susceptibility to drugs toxicity have historically limited treatment in these patients. Recent approval of interferon-free regimens, characterized by high efficacy and limited toxicity, provides unprecedented chances for these patients to be cured. The aim of this study is to assess cost-effectiveness, taking into account the severity of liver disease, age, and the geriatric (frailty) status. Methods: A semi-Markov model of CHC natural history was built. The study focuses on CHC patients older than 65 years, stratified according to liver fibrosis (METAVIR F3 and F4), age (65–85 years old) and Fried’s frailty phenotype (not frail, pre-frail and frail) generating 30 simulated cohorts. Treatment with sofosbuvir plus simeprevir (SOF/SMV) versus no treatment was assessed for each cohort. The model estimated costs, Life Years and Quality Adjusted Life Years (QALY), with a lifetime time horizon and the Health System perspective. Results are presented as incremental costeffectiveness ratios (ICERs) per QALY gained. Cost-effectiveness was defined as an ICER under the 37,000D threshold. Results: At each fibrosis score, ICER increased with age and frailty index. Among F3 patients, ICER ranged from D13,934 in notfrail 65-years-old andD79,354 in frail 85-years-old patients. Among F4 patients ICER ranged from D13,873 in not frail 65-years-old and D115,965 in frail 85-years-old patients. In both F3 and F4 cohorts ICER was below D37,000/QALY up to age 80 in non-frail patients, up to age 75 in pre-frail patients, up to age 70 in frail patients. Conclusion: SOF/SMV treatment is cost-effective in most CHC patients older than 65 years, however a careful assessment of the patient geriatric status is mandatory. This cost-effectiveness analysis should promote a prospective clinical study to verify efficacy and side effects in elderly HCV patients.
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