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Cost‐effectiveness analysis of ledipasvir/sofosbuvir in patients with chronic hepatitis C: Treatment of patients with absence or mild fibrosis compared to patients with advanced fibrosis
Author(s) -
Buti M.,
DomínguezHernández R.,
Oyagüez I.,
Casado M. A.,
Esteban R.
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.12704
Subject(s) - medicine , sofosbuvir , cirrhosis , hepatocellular carcinoma , chronic hepatitis , cohort , gastroenterology , ledipasvir , liver disease , hepatitis c , surgery , ribavirin , immunology , virus
Summary To evaluate the cost‐effectiveness of ledipasvir/sofosbuvir ( LDV / SOF ) in treatment‐naïve patients with chronic hepatitis C ( CHC ) genotype 1 ( GT 1) in the absence or mild fibrosis (F0‐F1) versus advanced fibrosis (F2‐F4), from the perspective of the Spanish Health System. A Markov model was developed to simulate disease progression, estimating costs and outcomes [life years gained ( LYG ) and quality‐adjusted life years ( QALY )] derived from starting with LDV / SOF in patients with F0‐F1 compared with F2‐F4. Therapy duration was 8 weeks in noncirrhotic patients with viral load <6 million IU / mL and 12 weeks in the remaining patients. Sustained virologic response rates were obtained from real‐world cohort studies. Transition probabilities, utilities and direct costs were obtained from the literature. A 3% annual discount rate was applied to costs and outcomes. Sensitivity analyses were performed. LDV / SOF in F0‐F1 patients was a dominant strategy, being more effective (19.85 LYG and 19.80 QALY ) than beginning treatment in F2‐F4 patients (18.63 LYG and 16.25 QALY ), generating savings of €9228 per patient (€3661 due to disease management and monitoring). In a cohort of 1000 patients, LDV / SOF in F0‐F1 patients decreased the number of cases of decompensated cirrhosis (93%), hepatocellular carcinoma (97%) and liver‐related deaths (95%) and prevented 6 liver transplants compared to initiating LDV / SOF in F2‐F4 patients. In CHC treatment‐naïve GT 1 patients, starting treatment with LDV / SOF in patients with F0‐F1 compared to those with F2‐F4 increases effectiveness by 1.22 LYG and 3.55 QALY gained and reduces disease burden and it is associated with cost savings.