Academic journal article Applied Health Economics and Health Policy

Cost-Effectiveness Analysis of Boceprevir for the Treatment of Chronic Hepatitis C Virus Genotype 1 Infection in Portugal

Academic journal article Applied Health Economics and Health Policy

Cost-Effectiveness Analysis of Boceprevir for the Treatment of Chronic Hepatitis C Virus Genotype 1 Infection in Portugal

Article excerpt

Published online: 26 January 2013

© Springer International Publishing Switzerland 2013


Background The recent approval of two protease inhibitors, boceprevir and telaprevir, is likely to change the management of chronic hepatitis C virus (HCV) genotype 1 infection.

Objectives We evaluated the long-term clinical outcomes and the cost effectiveness of therapeutic strategies using boceprevir with peginterferon plus ribavirin (PR) in comparison with PR alone for treating HCV genotype 1 infection in Portugal.

Methods A Markov model was developed to project the expected lifetime costs and quality-adjusted life-years (QALYs) associated with PR alone and the treatment strategies outlined by the European Medicines Agency in the boceprevir summary of product characteristics. The boceprevir-based therapeutic strategies differ according to whether or not the patient was previously treated and whether or not the patient had compensated cirrhosis. The model simulated the experience of a series of cohorts of chronically HCV-infected patients (each defined by age, sex, race and fibrosis score). All treatment-related inputs were obtained from boceprevir clinical trials - SPRINT-2, RESPOND-2 and PROVIDE. Estimates of the natural history parameters and health state utilities were based on published studies. Portugal-specific annual direct costs of HCV health states were estimated by convening a panel of experts to derive health state resource use and multiplying the results by national unit costs. The model was developed from a healthcare system perspective with a timeframe corresponding to the remaining duration of the patients' lifetimes. Both future costs and QALYs were discounted at 5 %. To test the robustness of the conclusions, we conducted deterministic and probabilistic sensitivity analyses.

Results In comparison with the treatment with PR alone, boceprevir-based regimens were projected to reduce the lifetime incidence of advanced liver disease, liver transplantation, and liver-related death by 45-51 % and increase life expectancy by 2.3-4.3 years. Although the addition of BOC increased treatment costs by euro13,300-euro19,700, the reduction of disease burden resulted in a decrease of euro5,400-euro9,000 in discounted health state costs and an increase of 0.68-1.23 in discounted QALYs per patient. The incremental cost-effectiveness ratios of the boceprevirbased regimens compared with PR among previously untreated and previously treated patients were euro11,600/ QALY and euro8,700/QALY, respectively. The results were most sensitive to variations in sustained virologic response rates, discount rates and age at treatment.

Conclusions Adding boceprevir to PR was projected to reduce the number of liver complications and liver-related deaths, and to be cost effective in treating both previously untreated and treated patients.

1 Introduction

Chronic hepatitis C virus (HCV) infection is a major cause of liver disease. According to the World Health Organization, 130-170 million people worldwide are currently chronically infected with HCV and are at risk of developing liver cirrhosis and/or liver cancer [1]. Despite the limitations of the data, the current prevalence of HCV in Portugal is estimated at around 1.5 %, which corresponds to an estimated total of between 100,000 and 150,000 infected persons [2]. Out of the six main HCV genotypes [3], genotype 1 is the most common in Portugal (52 %), followed by genotypes 3 and 4 [4]. Most infections occur among men, with an average age of infection ranging between 15 and 54 years [5]. The large pool of chronic infections, together with the slow course of HCV disease [6], is predicted to lead to a significant increase in the number of patients with terminal liver disease [7], hepatocellular carcinoma (HCC) and liver-related deaths in the next 10-20 years in Portugal [5, 8].

The standard of care (S°C) for chronic HCV infection genotype 1 has been 48 weeks of treatment with a combination of a pegylated interferon alfa and ribavirin (PR). …

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