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Cost-Effectiveness of Genotype 1 Chronic Hepatitis C Virus Treatments in Patients Coinfected with Human Immunodeficiency Virus in the United States

Abstract

Introduction

New treatments for chronic hepatitis C virus (HCV) are highly effective in patients coinfected with human immunodeficiency virus (HIV). This study estimated the cost-effectiveness of treatments for genotype 1 (GT1) HCV in HIV-coinfected patients.

Methods

A Markov model based on HCV natural history was used. The base-case analysis included both treatment-naïve and -experienced patients. Alternatives were ombitasvir/paritaprevir/ritonavir, dasabuvir with or without ribavirin (3D ± R) for 12 or 24 weeks, sofosbuvir plus peginterferon and R (SOF + PR) for 12 weeks, SOF + R for 24 weeks, and no treatment (NT). A subgroup analysis restricted to treatment-naïve, non-cirrhotic patients compared 3D ± R for 12 weeks to SOF plus ledipasvir (LDV) for 12 weeks and NT. Transition probabilities, utilities, and costs were obtained from the published literature. Outcomes were measured over a lifetime horizon and included rates of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver-related death, total costs, life-years, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER).

Results

In the base-case, SOF + R was dominated by both SOF + PR and 3D ± R. Compared to SOF + PR, 3D ± R had an ICER of $45,581. The lifetime rates of liver morbidity and mortality were lower among those treated with 3D ± R compared to SOF + PR, SOF + R, or NT. In the subgroup analysis, 3D ± R was cost-effective compared to NT at a threshold of $50,000 per QALY (ICER $27,496). SOF/LDV had an ICER of $104,489 per QALY gained compared to 3D ± R.

Conclusion

In the GT1 HCV population coinfected with HIV, 3D ± R was cost-effective compared to NT, SOF + R, and SOF + PR. In the treatment-naïve sub-population, 3D ± R was cost-effective compared to NT and SOF/LDV.

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Acknowledgments

Design, analysis, and financial support of this study were provided by AbbVie. AbbVie is the manufacturer of ombitasvir/paritaprevir/ritonavir, dasabuvir (3D, Viekira Pak™) which is one of the drugs included in the analysis. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. The authors gratefully acknowledge the assistance of Glen Schumock at Second City Outcome Research LLC in drafting and editing the manuscript. AbbVie provided funding to Second City Outcome Research LLC for drafting and editing the manuscript. AbbVie also funded the article processing charges for this publication.

Disclosures

Sammy Saab is employed by the Pfleger Liver Institute at UCLA and is a consultant for AbbVie. He is also a consultant and on the speaker bureau for BMS, Gilead, Merck and Janssen pharmaceuticals. Suchin Virabhak and Scott Johnson are employed by Medicus Economics LLC, which received payment from AbbVie to undertake research. Hélène Parisé is a contractor for Medicus Economics LLC. Alice Wang, Yuri Sanchez Gonzalez, and Timothy Juday are AbbVie employees and may own AbbVie stock. Derek Misurski is a former AbbVie employee and may own AbbVie stock.

Compliance with Ethics Guidelines

This article is based on previously conducted studies, and does not involve any new studies of human or animal subjects performed by any of the authors.

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Correspondence to Alice Wang.

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Saab, S., Virabhak, S., Parisé, H. et al. Cost-Effectiveness of Genotype 1 Chronic Hepatitis C Virus Treatments in Patients Coinfected with Human Immunodeficiency Virus in the United States. Adv Ther 33, 1316–1330 (2016). https://doi.org/10.1007/s12325-016-0362-1

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  • DOI: https://doi.org/10.1007/s12325-016-0362-1

Keywords

  • Cost-effectiveness
  • Direct-acting antivirals
  • Hepatitis C virus
  • Human immunodeficiency virus
  • Infectious diseases