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Cost‐effectiveness of elbasvir/grazoprevir use in treatment‐naive and treatment‐experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States
Author(s) -
Elbasha E.,
Greaves W.,
Roth D.,
Nwankwo C.
Publication year - 2017
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12639
Subject(s) - medicine , ribavirin , kidney disease , pegylated interferon , regimen , hepatitis c , transplantation , hepatitis c virus , immunology , virus
Summary Among patients with chronic kidney disease ( CKD ) in the United States, HCV infection causes significant morbidity and mortality and results in substantial healthcare costs. A once‐daily oral regimen of elbasvir/grazoprevir ( EBR / GZR ) for 12 weeks was found to be a safe and efficacious treatment for HCV in patients with CKD . We evaluated the cost‐effectiveness of EBR / GZR in treatment‐naïve and treatment‐experienced CKD patients compared with no treatment (NoTx) and pegylated interferon plus ribavirin (peg‐ IFN / RBV ) using a computer‐based model of the natural history of chronic HCV genotype 1 infection, CKD and liver disease. Data on baseline characteristics of the simulated patients were obtained from NHANES , 2000–2010. Model inputs were estimated from published studies. Cost of treatment with EBR / GZR and peg‐ INF / RBV were based on wholesale acquisition cost. All costs were from a third‐party payer perspective and were expressed in 2015 U.S. dollars. We estimated lifetime incidence of liver‐related complications, liver transplantation, kidney transplantation, end‐stage live disease mortality and end‐stage renal disease mortality; lifetime quality‐adjusted life years ( QALY ); and incremental cost‐utility ratios ( ICUR ). The model predicted that EBR / GZR will significantly reduce the incidence of liver‐related complications and prolong life in patients with chronic HCV genotype 1 infection and CKD compared with NoTx or use of peg‐ IFN / RBV . EBR / GZR ‐based regimens resulted in higher average remaining QALY s and higher costs (11.5716, $191 242) compared with NoTx (8.9199, $156 236) or peg‐ INF / RBV (10.2857, $186 701). Peg‐ IFN / RBV is not cost‐effective, and the ICUR of EBR / GZR compared with NoTx was $13 200/ QALY . Treatment of a patient on haemodialysis with EBR / GZR resulted in a higher ICUR ($217 000/ QALY ). Assuming a threshold of $100 000 per QALY gained for cost‐effectiveness, use of elbasvir/grazoprevir to treat an average patient with CKD can be considered cost‐effective in the United States.