A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic Hepatitis C virus
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Published version
Author(s)
Fawsitt, Christopher G
Vickerman, Peter
Cooke, Graham
Welton, Nicky J
STOP-HCV Consortium
Type
Journal Article
Abstract
BACKGROUND: Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. OBJECTIVES: To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients. METHODS: Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies. RESULTS: The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course. CONCLUSIONS: Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective.
Date Issued
2019-06-01
Date Acceptance
2018-12-29
Citation
Value in Health, 2019, 22 (6), pp.693-703
ISSN
1098-3015
Publisher
Elsevier
Start Page
693
End Page
703
Journal / Book Title
Value in Health
Volume
22
Issue
6
Copyright Statement
© 2019 ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Sponsor
National Institute for Health Research
Medical Research Council (MRC)
National Institute for Health Research
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31198187
PII: S1098-3015(19)30101-9
Grant Number
EME/14/02/17
MR/P025064/1
RP-2016-07-012
Subjects
cost-effectiveness
direct-acting antivirals
hepatitis C virus
shortened treatment duration
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-05-17