TY - JOUR
T1 - Modeling cost-effectiveness and health gains of a “universal“ versus “prioritized“ hepatitis C virus treatment policy in a real-life cohort
AU - Montalto, Giuseppe
AU - Craxi, Antonio
AU - Raimondo, Giovanni
AU - Vinci, Maria Letizia
AU - Cicchetti, Americo
AU - Kondili, Loreta A.
AU - Nardone, Gerardo
AU - Ciancio, Alessia
AU - Chemello, Liliana
AU - Puoti, Massimo
AU - Coppola, Carmine
AU - Rumi, Maria Grazia
AU - Foti, Giuseppe
AU - Massari, Marco
AU - Zignego, Anna Linda
AU - Taliani, Gloria
AU - Borgia, Guglielmo
AU - Rosato, Stefano
AU - Andreone, Pietro
AU - Ruggeri, Matteo
AU - Brunetto, Maurizia Rossana
AU - Alberti, Alfredo
AU - Blanc, Pierluigi
AU - Russo, Francesco Paolo
AU - Ieluzzi, Donatella
AU - Villa, Erica
AU - Erne, Elke Maria
AU - Madonia, Salvatore
AU - Vinci, Maria
AU - Quaranta, Maria Giovanna
AU - Romano, Federica
AU - Ferrari, Carlo
AU - Zuin, Massimo
AU - Chessa, Luchino
AU - Di Leo, Alfredo
AU - Gasbarrini, Antonio
AU - Santantonio, Teresa Antonia
AU - Rolli, Francesca Romana
AU - Vella, Stefano
AU - Verucchi, Gabriella
AU - Gaeta, Giovanni Battista
AU - Raimondo, Giovanni
AU - Persico, Marcello
PY - 2017
Y1 - 2017
N2 - We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus-infected patients: policy 1, âuniversal,â treat all patients, regardless of fibrosis stage; policy 2, treat only âprioritizedâ patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus-infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies' cost-effectiveness. The patients' age and fibrosis stage, assumed DAA treatment cost of â¬15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of â¬30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was â¬8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was â¬19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post-sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (â¬15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages.
AB - We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus-infected patients: policy 1, âuniversal,â treat all patients, regardless of fibrosis stage; policy 2, treat only âprioritizedâ patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus-infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies' cost-effectiveness. The patients' age and fibrosis stage, assumed DAA treatment cost of â¬15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of â¬30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was â¬8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was â¬19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post-sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (â¬15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages.
KW - Hepatology
UR - http://hdl.handle.net/10447/248220
UR - http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1527-3350
M3 - Article
VL - 66
SP - 1814-1825-1825
JO - Hepatology
JF - Hepatology
SN - 0270-9139
ER -