Cost-Effectiveness of Boceprevir in Patients Previously Treated for Chronic Hepatitis C Genotype 1 Infection in the United States

Objectives: the phase 3 trial, Serine Protease Inhibitor Boceprevir and PegIntron/Rebeto1-2 (RESPOND-2), demonstrated that the addition of boceprevir (BOC) to peginterferon-ribavirin (PR) resulted in significantly higher rates of sustained virologic response (SVR) in previously treated patients with chronic hepatitis C virus (HCV) genotype-1 infection as compared with PR alone. We evaluated the cost-effectiveness of treatment with BOG in previously treated patients with chronic hepatitis C in the United States using treatment-related data from RESPOND-2 and PROVIDE studies. Methods: We developed a Markov cohort model to project the burden of HCV disease, lifetime costs, and quality-adjusted life-years associated with PR and two BOG based therapies response-guided therapy (BOC/RGT) and fixed duration therapy for 48 weeks (BOC/PR48). We estimated treatment-related inputs (efficacy, adverse events, and discontinuations) from clinical trials and obtained disease progression rates, costs, and quality-of-life data from published studies. We estimated the incremental cost-effectiveness ratio (ICER) for BOG-based regimens as studied in RESPOND 2, as well as by patient's prior response to treatment and the IL-28B genotype. Results: BOG-based regimens were projected to reduce the lifetime incidence of liver-related complications by 43% to 53% in comparison with treatment with PR. The ICER of BOG/RGT in comparison with that of PR was $30,200, and the ICER of BOC/PR48 in comparison with that of BOC/RGT was $91,500. At a willingness-to-pay threshold of $50,000, the probabilities of BOC/RGT and BOC/PR48 being the preferred option were 0.74 and 0.25, respectively. Conclusions: In patients previously treated for chronic HCV genotype-1 infection, BOG was projected to increase quality-adjusted life-years and reduce the lifetime incidence of liver complications. In addition, BOG-based therapies were projected to be cost-effective in comparison with PR alone at commonly used willingness-to-pay thresholds.