ORLANDO, Fla. — An orally administered, interferon-free regimen with a treat-all approach for patients with chronic hepatitis C may be more beneficial and more cost effective than interferon-based triple therapy, according to data presented at Digestive Disease Week.
Researchers used a decision analytic Markov model to compare four methods of treatment for chronic HCV genotype 1: Triple therapy with pegylated interferon, ribavirin and a direct-acting antiviral (DAA) with (method 1) or without biopsy guidance (method 2); and an orally administered, interferon-free regimen with (method 3) or without biopsy guidance (method 4). The methods that incorporated biopsy began treatment at fibrosis stage F2 – F4, with repeated biopsies every 5 years until patients were aged 70 years.
A treatment-naive, 50 year-old patient served as a reference case. Investigators based treatment outcomes for methods 3 and 4 on study results presented at scientific meetings, and baseline cost and utility for methods 3 and 4 were calibrated to match triple therapy.
“As all-oral regimens are in the process of being developed by various pharmaceutical and biotechnology companies, interest has been focused on efficacy and side-effect profiles of these therapies,” researcher Heshaam M. Mir, MD, director of research in the Liver & Obesity program at Inova Fairfax Hospital in Falls Church, Va., told Healio.com. “We did not see a great deal published in the literature nor presented at the major liver conferences discussing the economic impact of these all-oral regimens. We thought it would be an area of interest for the medical community.”
Heshaam M. Mir
Method 4 was the most cost-effective approach, with an incremental cost-effectiveness ratio (ICER) of $16,289 per quality-adjusted life-year (QALY). Departure from baseline cost and utility of oral therapy did not raise the ICER above $50,000/QALY for this approach. This treatment also presented the lowest risk for developing cirrhosis (6.8%), decompensation or hepatocellular carcinoma (11%) and transplantation (2.7%) and was linked to the largest number of QALYs (18.351) compared with the other methods.
“A validated Markov model showed that an all-oral, interferon-free, treat-all regimen was the most cost-effective approach for treating chronic hepatitis C genotype 1 patients,” Mir said. “In addition to the economic advantage, it reduced the number of chronic hepatitis C patients reaching advanced liver disease, and increased life expectancy.”
Disclosure: Researcher Zobair M. Younossi reported serving on advisory committees/review panels for Salix Pharmaceuticals, Vertex Pharmaceuticals, Tibotec and GlaxoSmithKline, along with consulting services for Gilead Sciences and Conatus Pharmaceuticals.
For more information:
Younossi ZM. Sa1067: Interferon-Based and Interferon-Free Regimens for Patients with Chronic Hepatitis C, Genotype 1: Potential Cost-Effectiveness of Biopsy-Guided Treatment Versus Treat All Strategies. Presented at: Digestive Disease Week 2013; May 18-21, Orlando, Fla.