Cost-effectiveness of boceprevir or telaprevir for untreated patients with genotype 1 chronic hepatitis C

Abstract

Randomized controlled trials (RCTs) show that triple therapy (TT) with peginterferon alpha, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon‐ribavirin dual therapy (DT) in the treatment of previously untreated patients with genotype 1 (G₁) chronic hepatitis C (CHC). We assessed the cost‐effectiveness of TT compared to DT in the treatment of untreated patients with G₁ CHC. We created a Markov Decision Model to evaluate, in untreated Caucasian patients age 50 years, weight 70 kg, with G₁ CHC and Metavir F2 liver fibrosis score, for a time horizon of 20 years, the cost‐effectiveness of the following five competing strategies: 1) boceprevir response‐guided therapy (BOC‐RGT); 2) boceprevir IL28B genotype‐guided strategy (BOC‐IL28B); 3) boceprevir rapid virologic response (RVR)‐guided strategy (BOC‐RVR); 4) telaprevir response‐guided therapy (TVR‐RGT); 5) telaprevir IL28B genotype‐guided strategy (TVR‐IL28B). Outcomes included life‐years gained (LYG), costs (in 2011 euros) and incremental cost‐effectiveness ratio (ICER). In the base‐case analysis BOC‐RVR and TVR‐IL28B strategies were the most effective and cost‐effective of evaluated strategies. LYG was 4.04 with BOC‐RVR and 4.42 with TVR‐IL28B. ICER compared with DT was €8.304 per LYG for BOC‐RVR and €11.455 per LYG for TVR‐IL28B. The model was highly sensitive to IL28B CC genotype, likelihood of RVR and sustained virologic response, and BOC/TVR prices. Conclusion: In untreated G₁ CHC patients age 50 years, TT with first‐generation protease inhibitors is cost‐effective compared with DT. Multiple strategies to reduce costs and improve effectiveness include RVR or genotype‐guided treatment. (HEPATOLOGY 2012;56:850–860)