BACKGROUND: Hepatitis C, caused by a single-stranded RNA virus, has become a global health problem. Infecting millions of individuals in the United States alone, chronic HCV infection can lead to devastating medical problems including cirrhosis and hepatocellular carcinoma. These problems create millions of dollars in health-care costs for treatment and management. This study determines the cost-effectiveness of hepatitis C treatment with the new generation of oral protease inhibitors. METHODS: A Markov model was constructed to simulate the progression of genotype-1 chronic hepatitis C disease in a cohort of 50-year-old patients. A decision tree, along with the Markov model, was then used to determine duration of disease, treatment success, progression of disease and mortality. At the end of each stage in the model, the cost and quality-adjusted life years (QALY) were summed for each individual. These were then used to calculate the overall cost-effectiveness ratio (CER) using QALY as the unit of effectiveness. Four treatment options were modelled: sofosbuvir with pegylated interferon-α and ribavirin (SOF/PEG-IFN+RBV), sofosbuvir with ribavirin (SOF/RBV), simeprevir with pegylated interferon-α and ribavirin (SMV/PEG-IFN+RBV) and simeprevir with sofosbuvir (SMV/SOF). RESULTS: SOF/PEG-IFN+RBV yielded a CER ratio of $6,796.22/QALY, SMV/PEG-IFN+RBV of $7,642.60/QALY and SMV/SOF of $8,959.11/QALY. SOF/RBV had a higher CER of $16,295.30/QALY. It is important to note however that SMV/SOF had the highest QALY at 19.08. CONCLUSIONS: After consideration of quality of life, treatment regimens and treatment side effects, the SMV/SOF regimen yields acceptable cost-effectiveness ratios with high QALY.
BACKGROUND:Hepatitis C, caused by a single-stranded RNA virus, has become a global health problem. Infecting millions of individuals in the United States alone, chronic HCV infection can lead to devastating medical problems including cirrhosis and hepatocellular carcinoma. These problems create millions of dollars in health-care costs for treatment and management. This study determines the cost-effectiveness of hepatitis C treatment with the new generation of oral protease inhibitors. METHODS: A Markov model was constructed to simulate the progression of genotype-1 chronic hepatitis C disease in a cohort of 50-year-old patients. A decision tree, along with the Markov model, was then used to determine duration of disease, treatment success, progression of disease and mortality. At the end of each stage in the model, the cost and quality-adjusted life years (QALY) were summed for each individual. These were then used to calculate the overall cost-effectiveness ratio (CER) using QALY as the unit of effectiveness. Four treatment options were modelled: sofosbuvir with pegylated interferon-α and ribavirin (SOF/PEG-IFN+RBV), sofosbuvir with ribavirin (SOF/RBV), simeprevir with pegylated interferon-α and ribavirin (SMV/PEG-IFN+RBV) and simeprevir with sofosbuvir (SMV/SOF). RESULTS:SOF/PEG-IFN+RBV yielded a CER ratio of $6,796.22/QALY, SMV/PEG-IFN+RBV of $7,642.60/QALY and SMV/SOF of $8,959.11/QALY. SOF/RBV had a higher CER of $16,295.30/QALY. It is important to note however that SMV/SOF had the highest QALY at 19.08. CONCLUSIONS: After consideration of quality of life, treatment regimens and treatment side effects, the SMV/SOF regimen yields acceptable cost-effectiveness ratios with high QALY.
Authors: Eric Lawitz; Jay P Lalezari; Tarek Hassanein; Kris V Kowdley; Fred F Poordad; Aasim M Sheikh; Nezam H Afdhal; David E Bernstein; Edwin Dejesus; Bradley Freilich; David R Nelson; Douglas T Dieterich; Ira M Jacobson; Donald Jensen; Gary A Abrams; Jama M Darling; Maribel Rodriguez-Torres; K Rajender Reddy; Mark S Sulkowski; Natalie H Bzowej; Robert H Hyland; Hongmei Mo; Ming Lin; Michael Mader; Robert Hindes; Efsevia Albanis; William T Symonds; Michelle M Berrey; Andrew Muir Journal: Lancet Infect Dis Date: 2013-03-15 Impact factor: 25.071
Authors: Eric Lawitz; Alessandra Mangia; David Wyles; Maribel Rodriguez-Torres; Tarek Hassanein; Stuart C Gordon; Michael Schultz; Mitchell N Davis; Zeid Kayali; K Rajender Reddy; Ira M Jacobson; Kris V Kowdley; Lisa Nyberg; G Mani Subramanian; Robert H Hyland; Sarah Arterburn; Deyuan Jiang; John McNally; Diana Brainard; William T Symonds; John G McHutchison; Aasim M Sheikh; Zobair Younossi; Edward J Gane Journal: N Engl J Med Date: 2013-04-23 Impact factor: 91.245
Authors: Anuoluwapo Osinusi; Eric G Meissner; Yu-Jin Lee; Dimitra Bon; Laura Heytens; Amy Nelson; Michael Sneller; Anita Kohli; Lisa Barrett; Michael Proschan; Eva Herrmann; Bhavana Shivakumar; Wenjuan Gu; Richard Kwan; Geb Teferi; Rohit Talwani; Rachel Silk; Colleen Kotb; Susan Wroblewski; Dawn Fishbein; Robin Dewar; Helene Highbarger; Xiao Zhang; David Kleiner; Brad J Wood; Jose Chavez; William T Symonds; Mani Subramanian; John McHutchison; Michael A Polis; Anthony S Fauci; Henry Masur; Shyamasundaran Kottilil Journal: JAMA Date: 2013-08-28 Impact factor: 56.272
Authors: Nezam Afdhal; K Rajender Reddy; David R Nelson; Eric Lawitz; Stuart C Gordon; Eugene Schiff; Ronald Nahass; Reem Ghalib; Norman Gitlin; Robert Herring; Jacob Lalezari; Ziad H Younes; Paul J Pockros; Adrian M Di Bisceglie; Sanjeev Arora; G Mani Subramanian; Yanni Zhu; Hadas Dvory-Sobol; Jenny C Yang; Phillip S Pang; William T Symonds; John G McHutchison; Andrew J Muir; Mark Sulkowski; Paul Kwo Journal: N Engl J Med Date: 2014-04-11 Impact factor: 91.245