Cost-effectiveness of boceprevir or telaprevir for untreated patients with genotype 1 chronic hepatitis C

BACKGROUND AND AIMS: Randomized controlled trials (RCTs) show that triple therapy (TT) with peginterferon alfa, ribavirin and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of previously untreated patients with genotype 1 (G1) chronic hepatitis C (CHC). We assess the cost-effectiveness of TT compared to DT in the treatment of untreated patients with G1 CHC. METHODS: We created a Markov Decision Model to evaluate, in an untreated Caucasian patients aged 50 years, weight 70 kg, with G1 CHC and Metavir F2 liver fibrosis score, for a time horizon of twenty years, the cost-effectiveness of the following 5 competing strategies: 1) Boceprevir response-guided therapyy (BOC-RGT); 2) Boceprevir IL28B genotype-guided strategy (BOC-IL28B); 3) Boceprevir rapid virologic response (RVR) guided strategy (BOC-RVR); 4) Telaprevir response-guided theapyy (TVR-RGT); 5) Telaprevir IL28B genotype-guided strategy (TVR-IL28B). Outcomes included life-years gained (LYG), costs (in 2011 euros), and incremental cost-effectiveness ratio (ICER). RESULTS: In the base case analysis BOC-RVR and TVR-IL28B strategies were the most effective and cost-effective of evaluated strategies. LYG was 4.04 with BOC-RVR, and 4.42 with TVR-IL28B. ICER compared with DT was €8.304 per LYG for BOC-RVR, and €11.455 per LYG for TVR-IL28B. The model was highly sensitive to IL28B CC genotype, likelihood of RVR and of sustained virologic response, and BOC/TVR prices. CONCLUSIONS: In untreated G1 CHC patients aged 50 years, TT with first generation protease inhibitors is cost-effective compared with DT. Multiple strategies to reduce costs and improve effectiveness include RVR or genotype-guided treatment. (HEPATOLOGY 2012.).