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

Background & Aims: Randomised controlled trials (RCTs) show that triple therapy (TT) with peginterferon alfa, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of genotype 1 (G1) chronic hepatitis C (CHC) patients with previous relapse (RR), partial response (PAR), and null-response (NR). We assess the cost-effectiveness of TT compared to no therapy in the treatment of patients previously treated with G1 CHC. Methods: The available published literature provided the data source. The target population was made up of previously treated Caucasian patients with G1 CHC and these were evaluated over a lifetime horizon by Markov model. The study was carried out from the perspective of the Italian National Health Service. Outcomes included discounted costs (in euro at 2012 value), life years gained (LYG), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER). The robustness of the results was evaluated by one-way deterministic and multivariable probabilistic sensitivity analyses. Results: In RR patients, ICER per LYG compared to no therapy was epsilon 9555 for BOC-LEAD-IN-RR and epsilon 7910 for TVR-LEAD-IN-RR, being BOC dominated by TVR. In PAR patients, ICER for LYG was epsilon 11,947 for BOC-LEAD-IN-PAR and epsilon 14,931 for TVR-PAR, being TVR cost-effective compared to BOC (ICER for QALY epsilon 22,258). In NR patients, ICER for LYG was epsilon 26,499 for TVR-LEAD-IN-NR. The models were sensitive to likelihood of sustained virological Conclusions: 1st generation HCV PI is highly cost-effective compared to no therapy in RR and PAR G1 CHC patients. TVR dominated BOC in RR, and was cost-effective compared to BOC in PAR patients. In NR patients an assessment of the response after a lead-in period should be performed to improve safety and costeffectiveness. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.