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
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.
This article is protected by copyright. All rights reserved.
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