Premium
Modeling cost‐effectiveness and health gains of a “universal” versus “prioritized” hepatitis C virus treatment policy in a real‐life cohort
Author(s) -
Kondili Loreta A.,
Romano Federica,
Rolli Francesca Romana,
Ruggeri Matteo,
Rosato Stefano,
Brunetto Maurizia Rossana,
Zignego Anna Linda,
Ciancio Alessia,
Di Leo Alfredo,
Raimondo Giovanni,
Ferrari Carlo,
Taliani Gloria,
Borgia Guglielmo,
Santantonio Teresa Antonia,
Blanc Pierluigi,
Gaeta Giovanni Battista,
Gasbarrini Antonio,
Chessa Luchino,
Erne Elke Maria,
Villa Erica,
Ieluzzi Donatella,
Russo Francesco Paolo,
Andreone Pietro,
Vinci Maria,
Coppola Carmine,
Chemello Liliana,
Madonia Salvatore,
Verucchi Gabriella,
Persico Marcello,
Zuin Massimo,
Puoti Massimo,
Alberti Alfredo,
Nardone Gerardo,
Massari Marco,
Montalto Giuseppe,
Foti Giuseppe,
Rumi Maria Grazia,
Quaranta Maria Giovanna,
Cicchetti Americo,
Craxì Antonio,
Vella Stefano
Publication year - 2017
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.29399
Subject(s) - medicine , cohort , cost effectiveness , quality adjusted life year , population , incremental cost effectiveness ratio , health care , cost–benefit analysis , pediatrics , environmental health , risk analysis (engineering) , ecology , economics , biology , economic growth
We evaluated the cost‐effectiveness of two alternative direct‐acting antiviral (DAA) treatment policies in a real‐life cohort of hepatitis C virus–infected patients: policy 1, “universal,” treat all patients, regardless of fibrosis stage; policy 2, treat only “prioritized” patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus–infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies’ cost‐effectiveness. The patients’ age and fibrosis stage, assumed DAA treatment cost of €15,000/patient, and the Italian liver disease costs were used to evaluate quality‐adjusted life‐years (QALY) and incremental cost‐effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country‐specific health states costs and mean treatment cost of €30,000. For the Italian base‐case analysis, the cost‐effective ICER obtained using policy 1 was €8,775/QALY. ICERs remained cost‐effective in 94%‐97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was €19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0‐F3 post–sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost‐saving for the base price (€15,000) discounts of at least 75% applied in patients with F0‐F2 fibrosis. Conclusion : Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost‐effective; cost‐effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (H epatology 2017;66:1814–1825)