Economic Evaluation of the Hepatitis C Virus Treatment Extension to Early-Stage Fibrosis Patients: Evidence from the PITER Real-World Cohort

Americo Cicchetti, Matteo Ruggeri, Silvia Coretti, Federica Romano, Stefano Vella, Loreta A. Kondili

Risultato della ricerca: Contributo in rivistaArticolo in rivista

4 Citazioni (Scopus)

Abstract

Objectives: To conduct a cost-effectiveness analysis of two planning strategies of the second-generation direct-acting antiviral interferon-free regimens for the treatment of chronic hepatitis C virus infection. Methods: A lifetime multicohort model comprised 8125 real-life patients enrolled in the PITER (Italian platform for the study of viral hepatitis) registry, implemented by the ISS (Istituto Superiore di Sanità). Two treatment planning strategies were compared: 1) policy 1—treat all patients regardless of the stage of fibrosis (F0–F4) with second-generation direct-acting antivirals and 2) policy 2—treat patients at F3/F4 stage and those who are prioritized by the scientific guidelines first, and the remaining patients when they reach the F3 stage. Clinical outcomes and costs were evaluated by using a lifetime horizon Markov model and adopting the third-party payer perspective. Health outcomes were expressed in terms of quality-adjusted life-years (QALYs). A sensitivity analysis was run to explore first- and second-order uncertainty and heterogeneity. An expected value of perfect information analysis was also conducted. Results: Policy 1 exhibits an incremental cost-effectiveness ratio of €8,775/QALY gained and remains less than €30,000/QALY in 94% of realizations produced by the Monte-Carlo simulation. Such a proportion increases to 97% when adopting a threshold of €40,000/QALY gained. Conclusions: Moving from the urgency criterion to evidence-based escalating strategies when prioritizing the access to new anti–hepatitis C virus treatments is a good investment in health, whose affordability should be explored through context-specific budget impact analyses.
Lingua originaleEnglish
pagine (da-a)783-791
Numero di pagine9
RivistaValue in Health
Volume21
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antiviral Agents
  • Budgets
  • Computer Simulation
  • Cost-Benefit Analysis
  • DAA treatments
  • Drug Costs
  • Drug Therapy, Combination
  • Female
  • HCV
  • HCV treatment extension
  • Hepacivirus
  • Hepatitis C, Chronic
  • Humans
  • Italy
  • Liver Cirrhosis
  • Male
  • Markov Chains
  • Middle Aged
  • Models, Economic
  • Monte Carlo Method
  • Multivariate Analysis
  • Quality-Adjusted Life Years
  • Registries
  • Time Factors
  • Treatment Outcome
  • Uncertainty
  • Young Adult
  • cost-effectiveness model

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