The European Journal of Health Economics

, Volume 18, Issue 8, pp 1001–1011 | Cite as

Hepatitis C disease transmission and treatment uptake: impact on the cost-effectiveness of new direct-acting antiviral therapies

  • Hayley Bennett
  • Jason Gordon
  • Beverley Jones
  • Thomas Ward
  • Samantha Webster
  • Anupama Kalsekar
  • Yong Yuan
  • Michael Brenner
  • Phil McEwan
Original Paper

Abstract

Background

Hepatitis C virus (HCV) treatment can reduce the incidence of future infections through removing opportunities for onward transmission. This benefit is not captured in conventional cost-effectiveness evaluations of treatment and is particularly relevant in patient groups with a high risk of transmission, such as those people who inject drugs (PWID), where the treatment rates have been historically low. This study aimed to quantify how reduced HCV transmission changes the cost-effectiveness of new direct-acting antiviral (DAA) regimens as a function of treatment uptake rates.

Methods

An established model of HCV disease transmission and progression was used to quantify the impact of treatment uptake (10–100%), within the PWID population, on the cost-effectiveness of a DAA regimen versus pre-DAA standard of care, conducted using daclatasvir plus sofosbuvir in the UK setting as an illustrative example.

Results

The consequences of reduced disease transmission due to treatment were associated with additional net monetary benefit of £24,304–£90,559 per patient treated at £20,000/QALY, when 10–100% of eligible patients receive treatment with 100% efficacy. Dependent on patient genotype, the cost-effectiveness of HCV treatment using daclatasvir plus sofosbuvir improved by 36–79% versus conventional analysis, at 10–100% treatment uptake in the PWID population.

Conclusions

The estimated cost-effectiveness of HCV treatment was shown to improve as more patients are treated, suggesting that the value of DAA regimens to the NHS could be enhanced by improved treatment uptake rates among PWID. However, the challenge for the future will lie in achieving increased rates of treatment uptake, particularly in the PWID population.

Keywords

Hepatitis C virus Disease transmission Cost-effectiveness PWID 

JEL Classification

I1 

References

  1. 1.
    Shepard, C.W., Finelli, L., Alter, M.J.: Global epidemiology of hepatitis C virus infection. Lancet Infect. Dis. 5(9), 558–567 (2005)CrossRefPubMedGoogle Scholar
  2. 2.
    Hatzakis, A., Chulanov, V., Gadano, A.C., et al.: The present and future disease burden of hepatitis C virus (HCV) infections with today’s treatment paradigm—volume 2. J. Viral Hepat. 22(Suppl 1), 26–45 (2015)CrossRefPubMedGoogle Scholar
  3. 3.
    Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency: Hepatitis C in the UK: 2014 report. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/337115/HCV_in_the_UK_2014_24_July.pdf (2014). Accessed Jan 2015
  4. 4.
    Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency: Shooting up: infections among people who inject drugs in the United Kingdom 2013. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/370707/Shooting_Up_2014.pdf (2014). Accessed Jan 2015
  5. 5.
    Afdhal, N.H.: Hepatitis C viral infection in difficult-to-treat populations: an overview. Clin. Liver Dis. 1(3), 63–64 (2012)CrossRefGoogle Scholar
  6. 6.
    Kemmer, N., Neff, G.W.: Managing chronic hepatitis C in the difficult-to-treat patient. Liver Int. 27(10), 1297–1310 (2007)CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    European Association for the Study of the Liver: EASL clinical practice guidelines: management of hepatitis C virus infection. J. Hepatol. 60(2), 392–420 (2014)CrossRefGoogle Scholar
  8. 8.
    Sulkowski, M.S., Gardiner, D.F., Rodriguez-Torres, M., et al.: Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N. Engl. J. Med. 370(3), 211–221 (2014)CrossRefPubMedGoogle Scholar
  9. 9.
    Lawitz, E., Mangia, A., Wyles, D., et al.: Sofosbuvir for previously untreated chronic hepatitis C infection. N. Engl. J. Med. 368(20), 1878–1887 (2013)CrossRefPubMedGoogle Scholar
  10. 10.
    Gilead Sciences International Ltd: Summary of product characteristics. Sovaldi® 400 mg film-coated tablets. Updated June 2014. http://www.medicines.org.uk/emc/medicine/28539/SPC/Sovaldi+400+mg+film+coated+tablets/ (2014). Accessed Feb 2015
  11. 11.
    Janssen-Cilag Ltd: Summary of product characteristics. OLYSIO® 150 mg hard capsules. https://www.medicines.org.uk/emc/medicine/28888 (2014). Accessed Feb 2015
  12. 12.
    Scottish Medicines Consortium: Daclatasvir 30 and 60 mg film-coated tablets (Daklinza®). SMC No. 1002/14. https://www.scottishmedicines.org.uk/SMC_Advice/Advice/1002_14_daclatasvir_Daklinza/daclatasvir_Daklinza (2014). Accessed Jan 2015
  13. 13.
    Hagan, L.M., Sulkowski, M.S., Schinazi, R.F.: Cost analysis of sofosbuvir/ribavirin versus sofosbuvir/simeprevir for genotype 1 hepatitis C virus in interferon-ineligible/intolerant individuals. Hepatology 60(1), 37–45 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Petta, S., Cabibbo, G., Enea, M., et al.: Cost-effectiveness of sofosbuvir-based triple therapy for untreated patients with genotype 1 chronic hepatitis C. Hepatology 59(5), 1692–1705 (2014)CrossRefPubMedGoogle Scholar
  15. 15.
    Gordon, S.C., Pockros, P.J., Terrault, N.A., et al.: Impact of disease severity on healthcare costs in patients with chronic hepatitis C (CHC) virus infection. Hepatology 56(5), 1651–1660 (2012)CrossRefPubMedGoogle Scholar
  16. 16.
    Westbrook, R.H., Dusheiko, G.: Natural history of hepatitis C. J. Hepatol. 61(1), S58–S68 (2014)CrossRefPubMedGoogle Scholar
  17. 17.
    National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA331]. Simeprevir in combination with peginterferon alfa and ribavirin for treating genotypes 1 and 4 chronic hepatitis C. https://www.nice.org.uk/guidance/ta331 (2015). Accessed 16 Mar 2016
  18. 18.
    National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA364]. Daclatasvir for treating chronic hepatitis C. https://www.nice.org.uk/guidance/ta364 (2015). Accessed 16 Mar 2016
  19. 19.
    National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA330]. Sofosbuvir for treating chronic hepatitis C. https://www.nice.org.uk/guidance/ta330 (2015). Accessed 16 Mar 2016
  20. 20.
    National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA363]. Ledipasvir–sofosbuvir for treating chronic hepatitis C. https://www.nice.org.uk/guidance/ta363 (2015). Accessed 16 Mar 2016
  21. 21.
    National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA365]. Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C. https://www.nice.org.uk/guidance/ta365 (2015). Accessed 16 Mar 2016
  22. 22.
    National Institute for Health and Care Excellence: Single technology appraisal. Daclatasvir for treating chronic hepatitis C: final scope. http://www.nice.org.uk/guidance/gid-tag487/documents/hepatitis-c-chronic-daclatasvir-final-scope2 (2014). Accessed Feb 2015
  23. 23.
    National Institute for Health and Care Excellence: Single technology appraisal. Ledipasvir–sofosbuvir for treating chronic hepatitis C: final scope. http://www.nice.org.uk/guidance/gid-tag484/documents/hepatitis-c-chronic-ledipasvirsofosbuvir-final-scope2 (2014). Accessed Feb 2015
  24. 24.
    World Health Organization: Guidelines for the screening, care and treatment of persons with hepatitis C infection. http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/ (2014). Accessed Jan 2015
  25. 25.
    Martin, N.K., Vickerman, P., Foster, G.R., Hutchinson, S.J., Goldberg, D.J., Hickman, M.: Can antiviral therapy for hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modeling analysis of its prevention utility. J. Hepatol. 54(6), 1137–1144 (2011)CrossRefPubMedGoogle Scholar
  26. 26.
    Harris, R.J., Thomas, B., Griffiths, J., et al.: Increased uptake and new therapies are needed to avert rising hepatitis C-related end stage liver disease in England: modelling the predicted impact of treatment under different scenarios. J. Hepatol. 61(3), 530–537 (2014)CrossRefPubMedGoogle Scholar
  27. 27.
    Martin, N.K., Foster, G.R., Vilar, J., et al.: HCV treatment rates and sustained viral response among people who inject drugs in seven UK sites: real world results and modelling of treatment impact. J. Viral Hepat. 22(4), 399–408 (2015)CrossRefPubMedGoogle Scholar
  28. 28.
    Cousien, A., Tran, V.C., Deuffic-Burban, S., Jauffret-Roustide, M., Dhersin, J.S., Yazdanpanah, Y.: Dynamic modelling of hepatitis C virus transmission among people who inject drugs: a methodological review. J. Viral Hepat. 22(3), 213–229 (2015)CrossRefPubMedGoogle Scholar
  29. 29.
    Martin, N.K., Vickerman, P., Grebely, J., et al.: Hepatitis C virus treatment for prevention among people who inject drugs: modeling treatment scale-up in the age of direct-acting antivirals. Hepatology 58(5), 1598–1609 (2013)CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Hellard, M.E., Jenkinson, R., Higgs, P., et al.: Modelling antiviral treatment to prevent hepatitis C infection among people who inject drugs in Victoria, Australia. Med. J. Aust. 196(10), 638–641 (2012)CrossRefPubMedGoogle Scholar
  31. 31.
    Duberg, A.S., Blach, S., Falconer, K., Kaberg, M., Razavi, H., Aleman, S.: The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies. Scand. J. Gastroenterol. 50(2), 233–244 (2015)CrossRefPubMedGoogle Scholar
  32. 32.
    Martin, N.K., Vickerman, P., Dore, G.J., et al.: Prioiritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. J. Hepatol. 65(1), 17–25 (2016)Google Scholar
  33. 33.
    Bennett, H., McEwan, P., Sugrue, D., Kalsekar, A., Yuan, Y.: Assessing the long-term impact of treating hepatitis C virus (HCV)-Infected people who inject drugs in the UK and the relationship between treatment uptake and efficacy on future infections. PLoS One 10(5), e0125846 (2015)CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    McEwan, P., Kim, R., Yuan, Y.: Assessing the cost utility of response-guided therapy in patients with chronic hepatitis C genotype 1 in the UK using the MONARCH model. Appl. Health Econ. Health Policy 11(1), 53–63 (2013)CrossRefPubMedGoogle Scholar
  35. 35.
    McEwan, P., Ward, T., Chen, C.-J., et al.: Estimating the incidence and prevalence of chronic hepatitis C infection in Taiwan using back projection. Value Health Reg. Issues 3, 5–11 (2014)CrossRefGoogle Scholar
  36. 36.
    McEwan, P., Ward, T., Yuan, Y., Kim, R., L’Italien, G.: The impact of timing and prioritization on the cost-effectiveness of birth cohort testing and treatment for hepatitis C virus in the United States. Hepatology 58(1), 54–64 (2013)CrossRefPubMedGoogle Scholar
  37. 37.
    McEwan, P., Ward, T., Bennett, H., et al.: Estimating the clinical and economic benefit associated with incremental improvements in sustained virologic response in chronic hepatitis C. PLoS One 10(1), e0117334 (2015)CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Thein, H.H., Yi, Q., Dore, G.J., Krahn, M.D.: Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology 48(2), 418–431 (2008)CrossRefPubMedGoogle Scholar
  39. 39.
    Kanwal, F., Kramer, J.R., Ilyas, J., Duan, Z., El-Serag, H.B.: HCV genotype 3 is associated with an increased risk of cirrhosis and hepatocellular cancer in a national sample of US Veterans with HCV. Hepatology 60(1), 98–105 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Townsend, R., McEwan, P., Kim, R., Yuan, Y.: Structural frameworks and key model parameters in cost-effectiveness analyses for current and future treatments of chronic hepatitis C. Value Health 14(8), 1068–1077 (2011)CrossRefPubMedGoogle Scholar
  41. 41.
    Shepherd, J., Jones, J., Hartwell, D., Davidson, P., Price, A., Waugh, N.: Interferon alpha (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and economic evaluation. Health Technol. Assess. 11(11), 1–205 (2007)CrossRefPubMedGoogle Scholar
  42. 42.
    Pearlman, B.L., Traub, N.: Sustained virologic response to antiviral therapy for chronic hepatitis C virus infection: a cure and so much more. Clin. Infect. Dis. 52(7), 889–900 (2011)CrossRefPubMedGoogle Scholar
  43. 43.
    Akhtar, E., Manne, V., Saab, S.: Cirrhosis regression in hepatitis C patients with sustained virological response after antiviral therapy: a meta-analysis. Liver. Int. 35(1), 30–36 (2014)Google Scholar
  44. 44.
    Im, G.Y., Dieterich, D.T.: Direct-acting antiviral agents in patients with hepatitis C cirrhosis. Gastroenterol. Hepatol. (N. Y.) 8(11), 727–765 (2012)Google Scholar
  45. 45.
    Personal Social Services Research Unit: Unit costs of Health and Social Care 2013.  http://www.pssru.ac.uk/project-pages/unit-costs/2013/ (2013). Accessed Oct 2015
  46. 46.
    Public Health England: Commissioning template for estimating HCV prevalence by DAT and numbers eligible for treatment. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HepatitisC/EpidemiologicalData/ (2014). Accessed Feb 2015
  47. 47.
    Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency: Hepatitis C in the UK: 2013 report. http://www.hpa.org.uk/Publications/InfectiousDiseases/BloodBorneInfections/HepatitisCInTheUK/1307HepatitisCintheUK2013report/ (2013). Accessed Feb 2015
  48. 48.
    National Institute for Health and Care Excellence: Guide to the methods of technology appraisal 2013. http://www.nice.org.uk/article/pmg9 (2013). Accessed Feb 2015
  49. 49.
    Leidner, A.J., Chesson, H.W., Xu, F., Ward, J.W., Spradling, P.R., Holmberg, S.D.: Cost-effectiveness of hepatitis C treatment for patients in early stages of liver disease. Hepatology 61(6), 1860–1869 (2015)CrossRefPubMedGoogle Scholar
  50. 50.
    Leleu, H., Blachier, M., Rosa, I.: Cost-effectiveness of sofosbuvir in the treatment of patients with hepatitis C. J. Viral Hepat. 22(4), 376–383 (2015)CrossRefPubMedGoogle Scholar
  51. 51.
    The All-Party Parliamentary Hepatology Group: In the dark: an audit of hospital hepatitis C services across England. http://www.appghep.org.uk/wp-content/uploads/2014/02/In-The-Dark-An-audit-of-hospital-hepatitis-C-services-across-England-APPHG-2010.pdf (2010). Accessed Feb 2015
  52. 52.
    Arain, A., Robaeys, G.: Eligibility of persons who inject drugs for treatment of hepatitis C virus infection. World J. Gastroenterol. 20(36), 12722–12733 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Innes, H., Goldberg, D., Dillon, J., Hutchinson, S.J.: Strategies for the treatment of hepatitis C in an era of interferon-free therapies: what public health outcomes do we value most? Gut. 64(11), 1800–1809 (2014)Google Scholar
  54. 54.
    Hope, V.D., Hickman, M., Ngui, S.L., et al.: Measuring the incidence, prevalence and genetic relatedness of hepatitis C infections among a community recruited sample of injecting drug users, using dried blood spots. J Viral Hepat. 18(4), 262–270 (2011)CrossRefPubMedGoogle Scholar
  55. 55.
    Sweeting, M.J., Hope, V.D., Hickman, M., et al.: Hepatitis C infection among injecting drug users in England and Wales (1992–2006): there and back again? Am. J. Epidemiol. 170(3), 352–360 (2009)CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Kimber, J., Copeland, L., Hickman, M., et al.: Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment. BMJ 341, c3172 (2010)CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Hickman, M., Hope, V., Coleman, B., et al.: Assessing IDU prevalence and health consequences (HCV, overdose and drug-related mortality) in a primary care trust: implications for public health action. J. Public Health (Oxf.) 31(3), 374–382 (2009)CrossRefGoogle Scholar
  58. 58.
    Cornish, R., Macleod, J., Strang, J., Vickerman, P., Hickman, M.: Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ 341, c5475 (2010)CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Health Protection Scotland and University of the West of Scotland: Needle Exchange Surveillance Initiative (NESI): Prevalence of HCV, HIV and injecting risk behaviours among injecting drug users attending needle exchanges in Scotland, 2007. http://www.hps.scot.nhs.uk/search/atozdetail.aspx?source=8&subject=93 (2008). Accessed Feb 2015
  60. 60.
    Allen, E.J., Palmateer, N.E., Hutchinson, S.J., Cameron, S., Goldberg, D.J., Taylor, A.: Association between harm reduction intervention uptake and recent hepatitis C infection among people who inject drugs attending sites that provide sterile injecting equipment in Scotland. Int. J. Drug Policy 23(5), 346–352 (2012)CrossRefPubMedGoogle Scholar
  61. 61.
    University of the West of Scotland: The Needle Exchange Surveillance Initiative (NESI): Prevalence of HCV and injecting risk behaviours among people who inject drugs attending injecting provision services in Scotland, 2008/2009 and 2010. http://www.documents.hps.scot.nhs.uk/bbvsti/hepatitis-c/publications/nesi-needle-exchange.pdf (2011). Accessed Feb 2015
  62. 62.
    Vickerman, P., Martin, N., Turner, K., Hickman, M.: Can needle and syringe programmes and opiate substitution therapy achieve substantial reductions in hepatitis C virus prevalence? Model projections for different epidemic settings. Addiction 107(11), 1984–1995 (2012)CrossRefPubMedGoogle Scholar
  63. 63.
    Kemp, P.A., Neale, J., Robertson, M.: Homelessness among problem drug users: prevalence, risk factors and trigger events. Health Soc. Care Community 14(4), 319–328 (2006)CrossRefPubMedGoogle Scholar
  64. 64.
    Innes, H.A., Hutchinson, S.J., Allen, S., et al.: Ranking predictors of a sustained viral response for patients with chronic hepatitis C treated with pegylated interferon and ribavirin in Scotland. Eur. J. Gastroenterol. Hepatol. 24(6), 646–655 (2012)CrossRefPubMedGoogle Scholar
  65. 65.
    Micallef, J.M., Kaldor, J.M., Dore, G.J.: Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J. Viral Hepat. 13(1), 34–41 (2006)CrossRefPubMedGoogle Scholar
  66. 66.
    Mondelli, M.U., Cerino, A., Cividini, A.: Acute hepatitis C: diagnosis and management. J. Hepatol. 42(1), S108–S114 (2005)CrossRefPubMedGoogle Scholar
  67. 67.
    Turner, K.M.E., Hutchinson, S., Vickerman, P., et al.: The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction 106(11), 1978–1988 (2011)CrossRefPubMedGoogle Scholar
  68. 68.
    Aspinall, E.J., Corson, S., Doyle, J.S., et al.: Treatment of hepatitis C virus infection among people who are actively injecting drugs: a systematic review and meta-analysis. Clin. Infect. Dis. 57(suppl 2), S80–S89 (2013)CrossRefPubMedGoogle Scholar
  69. 69.
    Jacobson, I.M., McHutchison, J.G., Dusheiko, G., et al.: Telaprevir for previously untreated chronic hepatitis C virus infection. N. Engl. J. Med. 364(25), 2405–2416 (2011)CrossRefPubMedGoogle Scholar
  70. 70.
    Poordad, F., McCone Jr., J., Bacon, B.R., et al.: Boceprevir for untreated chronic HCV genotype 1 infection. N. Engl. J. Med. 364(13), 1195–1206 (2011)CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    National Institute for Health and Care Excellence: Technology appraisal TA106: peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C. http://guidance.nice.org.uk/TA106 (2006). Accessed Feb 2015
  72. 72.
    Wright, M., Grieve, R., Roberts, J., Main, J., Thomas, H.: Health benefits of antiviral therapy for mild chronic hepatitis C: randomised controlled trial and economic evaluation. Health. Technol. Assess. 10(21), 1–113, iii (2006)Google Scholar
  73. 73.
    Grieve, R., Roberts, J., Wright, M., et al.: Cost effectiveness of interferon alpha or peginterferon alpha with ribavirin for histologically mild chronic hepatitis C. Gut 55(9), 1332–1338 (2006)CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Martin, N.K., Vickerman, P., Miners, A., et al.: Cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations. Hepatology 55(1), 49–57 (2012)CrossRefPubMedGoogle Scholar
  75. 75.
    National Institute for Health and Care Excellence: Technology appraisal 252. Telaprevir for the treatment of genotype 1 chronic hepatitis C. Updated June 2014. http://www.nice.org.uk/ta252 (2012). Accessed Feb 2015
  76. 76.
    Personal Social Services Research Unit: Unit Costs of Health and Social Care. http://www.pssru.ac.uk/project-pages/unit-costs/2014/index.php (2014). Accessed Mar 2015
  77. 77.
    Haymarket Media Group Ltd: Monthly Index of Medical Specialities (MIMS). http://www.mims.co.uk/ (2015) Accessed Feb 2015
  78. 78.
    Bristol-Myers Squibb Pharmaceuticals Ltd: Final clinical study report AI444040 [data on file]. (2013)Google Scholar
  79. 79.
    Hadziyannis, S.J., Sette Jr., H., Morgan, T.R., et al.: Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann. Intern. Med. 140(5), 346–355 (2004)CrossRefPubMedGoogle Scholar
  80. 80.
    Nelson, D.R., Cooper, J.N., Lalezari, J.P., et al.: All-oral 12-week treatment with daclatasvir plus sofosbuvir in patients with hepatitis C virus genotype 3 infection: ALLY-3 phase III study. Hepatology 61(4), 1127–1135 (2015)CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Hayley Bennett
    • 1
  • Jason Gordon
    • 1
    • 2
  • Beverley Jones
    • 1
  • Thomas Ward
    • 1
  • Samantha Webster
    • 1
  • Anupama Kalsekar
    • 3
  • Yong Yuan
    • 3
  • Michael Brenner
    • 4
  • Phil McEwan
    • 1
    • 5
  1. 1.HEOR, Health Economics and Outcomes Research LtdCardiffUK
  2. 2.Department of Public HealthUniversity of AdelaideAdelaideAustralia
  3. 3.World Wide Health Economics and Outcomes ResearchBristol-Myers Squibb Pharmaceuticals LtdPrincetonUSA
  4. 4.UK HEOR, Bristol-Myers Squibb Pharmaceuticals LtdUxbridgeUK
  5. 5.School of Human and Health SciencesSwansea UniversitySwanseaUK

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