Thursday, March 16, 2017

Cost-effectiveness analysis of ledipasvir/sofosbuvir in patients with chronic hepatitis C: treatment of patients with absence or mild fibrosis compared to patients with advanced fibrosis

Buti M, et al. J Viral Hepat. 2017.

Original Paper
Cost-effectiveness analysis of ledipasvir/sofosbuvir in patients with chronic hepatitis C: treatment of patients with absence or mild fibrosis compared to patients with advanced fibrosis
Authors M. Buti, R. Domínguez-Hernández, I. Oyagüez, M A. Casado, R. Esteban

Accepted manuscript online: 8 March 2017
Full publication history DOI: 10.1111/jvh.12704

Summary
Objective
To evaluate the cost-effectiveness of Ledipasvir/Sofosbuvir (LDV/SOF) in treatment-naïve patients with chronic hepatitis C (CHC) genotype 1 (GT1) in the absence or mild fibrosis (F0-F1) versus advanced fibrosis (F2-F4), from the perspective of the Spanish Health System.

Methods
A Markov model was developed to simulate disease progression, estimating costs and outcomes [life years gained, (LYG), and quality adjusted life years, (QALY)] derived from starting with LDV/SOF in patients with F0-F1 compared with F2-F4. Therapy duration was 8 weeks in non-cirrhotic patients with viral load <6 million IU/mL and 12 weeks in the remaining patients. Sustained virologic response rates were obtained from real-world cohort studies. Transition probabilities, utilities and direct costs were obtained from the literature. A 3% annual discount rate was applied to costs and outcomes. Sensitivity analyses were performed.

Results
LDV/SOF in F0-F1 patients was a dominant strategy, being more effective (19.85 LYG and 19.80 QALY) than beginning treatment in F2-F4 patients (18.63 LYG and 16.25 QALY), generating savings of €9,228 per patient (€3,661 due to disease management and monitoring). In a cohort of 1,000 patients, LDV/SOF in F0-F1 patients decreased the number of cases of decompensated cirrhosis (93%), hepatocellular carcinoma (97%) and liver-related deaths (95%) and prevented 6 liver transplants compared to initiating LDV/SOF in F2-F4 patients.

Conclusions
In CHC treatment-naïve GT1 patients, starting treatment with LDV/SOF in patients with F0-F1 compared to those with F2-F4 increases effectiveness by 1.22 Life Years Gained (LYG), and 3.55 Quality-Adjusted Life Years (QALY) gained, reduces disease burden and it is associated with cost savings.
This article is protected by copyright. All rights reserved.

No comments:

Post a Comment