Skip to main content
SpringerLink
Log in

Protease Inhibitors for Hepatitis C: Economic Implications

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Chronic hepatitis C virus (HCV) infection, a blood-borne virus, is the leading cause of chronic liver disease and liver transplantation worldwide. Chronic HCV infection is usually asymptomatic in the early stages of the disease, making an estimation of the total population affected difficult to elicit. The gold standard treatment option to date has been a combination of pegylated interferon and ribavirin. Recent developments have led to the introduction of two protease inhibitors for use in chronic HCV—boceprevir and telaprevir. Phase III studies have shown both agents have the potential to significantly increase the probability of attaining a sustained virologic response (the primary outcome of interest in chronic HCV) in genotype 1 infections. However, the added cost of these agents also presents the need for decision makers to determine their place on drug formularies. The protease inhibitors are to be administered as triple therapy with the existing gold standard. However, significant variation exists as to the proposed duration of triple therapy, use of lead-in pegylated interferon and ribavirin and subsequent pegylated interferon therapy after finishing the course of triple therapy. Treatment algorithms also exist for the use of stopping rules in the case of early non-responders.

The aim of this review is to highlight the current understanding of the economic impact protease inhibitors may have on health care systems and considerations required in the treatment of HCV. Economic and health-related quality of life issues are addressed from multiple viewpoints. The major aspects of the economic evaluations, to date, that included triple therapy as an alternative in the treatment of chronic HCV are brought to light. Future economic evaluations in alternative settings would be useful. The review also emphasizes the challenges for future research. This includes the potential for new therapies to no longer require inclusion of pegylated interferon and/or ribavirin, as well as the use of protease inhibitors in non-genotype 1 patients or those with significant co-morbidities such as HIV/AIDS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Reference

  1. Seden K, Back D. Directly acting antivirals for hepatitis C and antiretrovirals: potential for drug–drug interactions. Curr Opin HIV AIDS. 2011;6:514–26.

    Article  PubMed  Google Scholar 

  2. Boyer N, Marcellin P. Pathogenesis, diagnosis and management of hepatitis C. J Hepatol. 2000;32(Suppl. 1):98–112.

    Article  PubMed  CAS  Google Scholar 

  3. Hepatitis C FAQs for health professionals. 2008 (August 4, 2011). http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section1. Cited 6 Apr 2012.

  4. Chak E, Talal A, Sherman K, Schiff E, Saab S. Hepatitis C virus infection in USA: an estimate of true prevalence. Liver Int. 2011;31(8):1090–101.

    Article  PubMed  Google Scholar 

  5. Jazwinski A, Muir A. Emerging therapies in hepatitis C: dawn of the era of the direct-acting antivirals. Gastroenterol Clin N Am. 2011;40:481–94.

    Article  Google Scholar 

  6. Marcellin P. Hepatitis C: the clinical spectrum of the disease. J Hepatol. 1999;31(Suppl 1):9–16.

    Article  PubMed  Google Scholar 

  7. Zapata R. Clinical approach to the patient with chronic hepatitis C infection and normal aminotransferases. Ann Hepatol. 2010;9(Suppl. 1):S72–9.

    CAS  Google Scholar 

  8. Bini E, Mehandru S. Sustained virological response rates and health-related quality of life after interferon and ribavirin therapy in patients with chronic hepatitis C virus infection and persistently normal alanine aminotransferase levels. Aliment Pharmacol Ther. 2006;23(6):777–85.

    Article  PubMed  CAS  Google Scholar 

  9. Uto H, Seiich M, Kumagai K, Ido A, Tsubouchi H. Clinical features of hepatitis C virus carriers with persistently normal alanine aminotransferase levels. Hepat Mon. 2012;12(2):77–84.

    PubMed  Google Scholar 

  10. Knodell R, Ishak K, Black W, Chen T, Craig R, Kaplowitz N, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology. 1981;1(5):431–5.

    Article  PubMed  CAS  Google Scholar 

  11. Choo Q, Kuo G, Weiner A, Overby L, Bradley D, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science. 1989;244(4902):359–62.

    Article  PubMed  CAS  Google Scholar 

  12. Kwong A, Kauffman R, Hurter P, Mueller P. Discovery and development of telaprevir: An NS3-4A protease inhibitor for treating genotype 1 chronic hepatitis C virus. Nat Biotechnol. 2011;29(11):993–1003.

    Article  PubMed  CAS  Google Scholar 

  13. Ghany M, Strader D, Thomas D, Seeff L. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49(4):1335–74.

    Article  PubMed  CAS  Google Scholar 

  14. Nelson P, Mathers B, Cowie B, Hagan H, Des Jarlais D, Horyniak D, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet. 2011;378(9791):571–83.

    Article  PubMed  Google Scholar 

  15. Martin N, Vickerman P, Foster G, Hutchinson S, Goldberg D, 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. 2011;54:1137–44.

    Article  PubMed  CAS  Google Scholar 

  16. Iqbal A, Akram M, Ali H, Akhtar N, Nazir S, Ahmad I, et al. Prevalence of hepatitis C virus (HCV) in Gadap Town Karachi, Pakistan. J Med Plant Res. 2011;5(25):6102–4.

    Google Scholar 

  17. Ocama P, Seremba E. Management of HIV and hepatitis C virus infections in resource-limited settings. Curr Opin HIV AIDS. 2011;6(6):539–45.

    Article  PubMed  Google Scholar 

  18. Linas B, Wong A, Schackman B, Kim A, Freedberg K. Cost-effective screening for acute hepatitis C virus infection in HIV-infected men who have sex with men. Clin Infect Dis. 2012 (epub ahead of print).

  19. USPSTF*. Screening for hepatitis C virus infection in adults: recommendation statement. Ann Intern Med. 2004;140(6):462–4.

  20. Sutton A, Edmunds W, Sweeting M, Gill O. The cost-effectiveness of screening and treatment for hepatitis C in prisons in England and Wales: a cost-utility analysis. J Viral Hepat. 2008;15(11):797–808.

    PubMed  CAS  Google Scholar 

  21. Tan J, Joseph T, Saab S. Treating hepatitis C in the prison population is cost-saving. Hepatology. 2008;48(5):1387–95.

    Article  PubMed  Google Scholar 

  22. Polywka S, Pembrey L, Tovo P-A, Newell M-L. Accuracy of HCV-RNA PCR tests for diagnosis or exclusion of vertically acquired HCV infection. J Med Virol. 2006;78(2):305–10.

    Article  PubMed  CAS  Google Scholar 

  23. Ghany M, Nelson D, Strader D, Thomas D, Seeff L. An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011;54(4):1433–44.

    Article  PubMed  Google Scholar 

  24. Poordad F, Reddy K, Martin P. Rapid virologic response: a new milestone in the management of chronic hepatitis C. Clin Infect Dis. 2008;46(1):78–84.

    Article  PubMed  Google Scholar 

  25. Marcellin P, Jensen D, Hadziyannis S, Ferenci P. Differentiation of early virologic response (EVR) into RVR, complete EVR (cEVR) and partial EVR (pEVR) allows for a more precise prediction of SVR in HCV genotype 1 patients treated with peginterferon alfa-2a (40KD) (PEGASYS) and ribavirin (COPEGUS). 58th Annual Meeting of the American Association for the Study of Liver Diseases; 2007 November 2–6; Boston, MA; 2007.

  26. Jun D, Tak W, Bae S, Lee Y. Recent trends in the treatment of chronic hepatitis C. Korean J Hepatol. 2012;18:22–8.

    Article  PubMed  Google Scholar 

  27. Davis G. New schedules of interferon for chronic hepatitis C. J Hepatol. 1999;31(Suppl. 1):227–31.

    Article  PubMed  Google Scholar 

  28. Hoofnagle J, Seeff L. Peginterferon and ribavirin for chronic hepatitis C. N Engl J Med. 2006;355(23):2444–51.

    Article  PubMed  CAS  Google Scholar 

  29. Rajendra A, Wong J. Economics of chronic hepatitis B and hepatitis C. J Hepatol. 2007;2007(47):4.

    Google Scholar 

  30. Sato K, Hashizume H, Yamazaki Y, Horiguchi N, Kakizaki S, Takagi H, et al. Response-guided peginterferon-alpha-2b plus ribavirin therapy for chronic hepatitis C patients with genotype 2 and high viral loads. Hepatology Research. 2012 (epub ahead of print).

  31. Niederau C, Hüppe D, Zehnter E, Möller B, Heyne R, Christensen S, et al. Chronic hepatitis C: treat or wait? Medical decision making in clinical practice. World J Gastroenterol. 2012;18(12):1339–47.

    Google Scholar 

  32. Dore G, Matthews G, Rockstroh J. Future of hepatitis C therapy: development of direct-acting antivirals. Curr Opin HIV AIDS. 2011;6:508–13.

    Article  PubMed  Google Scholar 

  33. Poordad F, McCone J, Bacon B, Bruno S, Manns M, Sulkowski M, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364(13):1195–206.

    Article  PubMed  CAS  Google Scholar 

  34. Lee L, Tong C, Wong T, Wilkinson M. New therapies for chronic hepatitis C infection: a systematic review of evidence from clinical trials. Int J Clin Pract. 2012;66(4):342–55.

    Article  PubMed  CAS  Google Scholar 

  35. Wong J. Hepatitis C cost of illness and considerations for the economic evaluation of antiviral therapies. Pharmacoeconomics. 2006;24(7):661–72.

    Article  PubMed  Google Scholar 

  36. Myers R, Ramji A, Bilodeau M, Wong S, Feld J. An update on the management of chronic hepatitis C: consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol. 2012;26(6):359–75.

    PubMed  Google Scholar 

  37. Ramachandran P, Fraser A, Agarwal K, Austin A, Brown A, Foster G, et al. UK consensus guidelines for the use of the protease inhibitors boceprevir and telaprevir in genotype 1 chronic hepatitis C infected patients. Aliment Pharmacol Ther. 2012;35(6):647–62.

    Article  PubMed  CAS  Google Scholar 

  38. Craxi A, Pawlotsky J-M, Wedemeyer H, Bjoro K, Flisiak R, Forns X, et al. EASL clinical practice guidelines: management of hepatitis C virus infection. J Hepatol. 2011;55:245–64.

    Article  Google Scholar 

  39. Hepatitis C for Health Care Providers—Hepatitis C. http://www.hepatitis.va.gov/provider/index.asp. Cited 15 Feb 2013.

  40. Tungol A, Rademacher K, Schafer J. Formulary management of the protease inhibitors boceprevir and telaprevir for chronic hepatitis C virus. J Manag Care Pharm. 2011;17(9):685–94.

    PubMed  Google Scholar 

  41. Solomon M, Bonafede M, Pan K, Wilson K, Beam C, Chakravarti P, et al. Direct medical care costs among pegylated interferon plus ribavirin-treated and untreated chronic hepatitis C patients. Dig Dis Sci. 2011;56(10):3024–31.

    Article  PubMed  CAS  Google Scholar 

  42. Krajden M, Kuo M, Zagorski B, Alvarez M, Yu A, Krahn M. Health care costs associated with hepatitis C: a longitudinal cohort study. Can J Gastroenterol. 2010;24(12):717–26.

    PubMed  Google Scholar 

  43. Maratea D, Messori A, Fadda V. Nationwide prediction of future expenditure for protease inhibitors in chronic hepatitis. Dig Liver Dis. 2012;44(1):86–7.

    Article  PubMed  Google Scholar 

  44. Davis K, Mitra D, Medjedovic J, Beam C, Rustgi V. Direct economic burden of chronic hepatitis C virus in a United States managed care population. J Clin Gastroenterol. 2011;45(2):e17–24.

    Article  PubMed  Google Scholar 

  45. Desai A, Reau N. Naives, nonresponders, relapsers: who is there left to treat? Clin Liver Dis. 2011;15(3):483–95.

    Article  PubMed  Google Scholar 

  46. Deuffic-Burban S, Mathurin P, Pol S, Larsen C, Roudot-Thorval F, Desenclos J, et al. Impact of hepatitis C triple therapy availability upon the number of patients to be treated and associated costs in France: a model-based analysis. Gut. 2012;61(2):290–6.

    Article  PubMed  CAS  Google Scholar 

  47. Freeman A, Dore G, Law M, Thorpe M, Von Overbeck J, Lloyd A, et al. Estimating progression to cirrhosis in chronic hepatitis C virus infection. Hepatology. 2001;34(4 Pt 1):809–16.

    Article  PubMed  CAS  Google Scholar 

  48. Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127(5 Suppl 1):S35–50.

    Article  PubMed  Google Scholar 

  49. Duberg A-S, Pettersson H, Aleman S, Blaxhult A, Daviasdottir L, Hultcrantz R, et al. The burden of hepatitis C in Sweden: a national study of inpatient care. J Viral Hepat. 2011;18(2):106–18.

    Article  PubMed  Google Scholar 

  50. McCombs J, Yuan Y, Shin J, Saab S. Economic burden associated with patients diagnosed with hepatitis C. Clin Ther. 2011;33(9):1268–80.

    Article  PubMed  Google Scholar 

  51. Lavancy D. The global burden of hepatitis C. Liver Int. 2009;29(s1):74–81.

    Article  Google Scholar 

  52. Myers R, Liu M, Shaheen A. The burden of hepatitis C virus infection is growing: a Canadian population-based study of hospitalizations from 1994 to 2004. Can J Gastroenterol. 2008;22(4):381–7.

    PubMed  Google Scholar 

  53. McAdam-Marx C, McGarry L, Hane C, Biskupiak J, Deniz B, Brixner D. All-cause and incremental per patient per year cost associated with chronic hepatitis C virus and associated liver complications in the United States: a managed care perspective. J Manag Care Pharm. 2011;17(7):531–46.

    PubMed  Google Scholar 

  54. Somsouk M, Langfield D, Inadomi J, Yee H Jr. A cost-identification analysis of screening and surveillance of hepatitis C infection in a prospective cohort of dialysis patients. Dig Dis Sci. 2008;53(4):1093–9.

    Article  PubMed  Google Scholar 

  55. Physician Quality Reporting System (Physician Quality Reporting) Measures List. 2011. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2011_PhysQualRptg_MeasuresList_033111.pdf. Cited 5 June 2012.

  56. Kanwal F, Schnitzler M, Bacon B, Hoang T, Buchanan P, Asch S. Quality of care in patients with chronic hepatitis C virus infection: a cohort study. Ann Inter Med. 2010;153(4):231–9.

    Article  Google Scholar 

  57. Novick D, Kreek M. Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients. Addiction. 2008;103(6):905–18.

    Article  PubMed  Google Scholar 

  58. Jafferbhoy H, Miller M, El Wahed Z, Dillon J. Pre-treatment prediction of response to pegylated-interferon plus ribavarin for chronic hepatitis C using RVR. J Hepatol. 2011;55(5):1162–4.

    Article  PubMed  CAS  Google Scholar 

  59. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.

    Article  PubMed  CAS  Google Scholar 

  60. Weiss J, Alcorn M, Rabkin J, Dieterich D. The critical role of medication adherence in the success of boceprevir and telaprevir in clinical practice. J Hepatol. 2012;56(2):503–4.

    Article  PubMed  Google Scholar 

  61. Marcellin P, Forns X, Goeser T, Ferenci P, Nevens F, Carosi G, et al. Telaprevir is effective given every 8 or 12 hours with ribavirin and peginterferon alfa-2a or -2b to patients with chronic hepatitis C. Gastroenterology. 2011;140:459–68.

    Article  PubMed  CAS  Google Scholar 

  62. Chang S-C, Ko W-S, Wu S-S, Peng C-Y, Yang S-S. Factors associated with quality of life in chronic hepatitis C patients who received interferon plus ribavirin therapy. J Formos Med Assoc. 2008;107(6):454–62.

    Article  PubMed  Google Scholar 

  63. Gheorghe L, Pascu O, Ceausu E, Csiki I, Jacob S, Caruntu F, et al. Access to peginterferon plus ribavirin therapy for hepatitis C in Romania between 2002–2009. J Gastroenterol Liver Dis. 2010;19(2):161–7.

    Google Scholar 

  64. Mitra D, Davis K, Beam C, Medjedovic J, Rustgi V. Treatment patterns and adherence among patients with chronic hepatitis C virus in a US managed care population. Value Health. 2010;13(4):479–86.

    Article  PubMed  Google Scholar 

  65. Sanyal C, Ingram E, Sketris I, Peltekian K, Kirkland S. Coping strategies used by patients infected with hepatitis C virus who are facing medication costs. Can J Hosp Pharm. 2011;64(2):131–40.

    PubMed  Google Scholar 

  66. Hsu P, Buxton J, Tu A, Hill W, Yu A, Krajden M. Publicly funded, pegylated interferon-alpha treatment in British Columbia: disparities in treatment patterns for people with hepatitis C. Can J Gastroenterol. 2008;22(4):359–64.

    PubMed  Google Scholar 

  67. Mehta S, Genberg B, Astemborski J, Kavasery R, Kirk G, Vlahov D, et al. Limited uptake of hepatitis C treatment among injection drug users. J Community Health. 2008;33(3):126–33.

    Article  PubMed  Google Scholar 

  68. Hepatitis C virus infection: prevalence report. 2003. http://www.health.state.mn.us/divs/idepc/diseases/hepc/stats/hcvprev2003.html. Cited 12 July 2012.

  69. Stepanova M, Kanwal F, El-Serag H, Younossi Z. Insurance status and treatment candidacy of hepatitis C patients: analysis of population-based data from the United States. Hepatology. 2011;53(3):737–45.

    Article  PubMed  Google Scholar 

  70. Fiscella K. Health care reform and equity: promise, pitfalls, and prescriptions. Ann Fam Med. 2011;9(1):78–84.

    Article  PubMed  Google Scholar 

  71. Linas B, Wang B, Smurzynski M, Losina E, Bosch R, Schackman B, et al. The impact of HIV/HCV co-infection on health care utilization and disability: results of the ACTG longitudinal linked randomized trials (ALLRT) cohort. J Viral Hepat. 2011;18(7):506–12.

    Article  PubMed  CAS  Google Scholar 

  72. Louie K, St Laurent S, Forssen U, Mundy L, Pimenta J. The high comorbidity burden of the hepatitis C virus infected population in the United States. BMC Infect Dis. 2012;12:86.

    Article  PubMed  Google Scholar 

  73. Modi A, Wright E, Seeff L. Complementary and alternative medicine (CAM) for the treatment of chronic hepatitis B and C: a review. Antivir Ther. 2007;12(3):285–95.

    PubMed  CAS  Google Scholar 

  74. Richmond J, Bailey D, Patel K, Jezsik J, Muir A, Lin J-R, et al. The use of complementary and alternative medicine by patients with chronic hepatitis C. Complement Ther Clin Pract. 2010;16(3):124–31.

    Article  PubMed  Google Scholar 

  75. Brook R, Kleinman N, Su J, Corey-Lisle P, Iloeje U. Absenteeism and productivity among employees being treated for hepatitis C. Am J Manag Care. 2011;17(10):657–64.

    PubMed  Google Scholar 

  76. Su J, Brook R, Kleinman N, Corey-Lisle P. The impact of hepatitis C virus infection on work absence, productivity, and healthcare benefit costs. Hepatology. 2010;52(2):436–42.

    Article  PubMed  Google Scholar 

  77. Davis G, Balart L, Schiff E, Lindsay K, Bodenheimer HJ, Perrillo R, et al. Assessing health-related quality of life in chronic hepatitis C using the sickness impact profile. Clin Ther. 1994;16(2):334–43.

    PubMed  CAS  Google Scholar 

  78. Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press; 2005.

    Google Scholar 

  79. Dai C-Y. Treatment uptake of patients with chronic hepatitis C: can we expect and do more? Dig Dis Sci. 2010;55(12):3300–3.

    Article  PubMed  Google Scholar 

  80. Jafferbhoy H, Gashau W, Dillon J. Cost effectiveness and quality of life considerations in the treatment of hepatitis C infection. Clinicoecon Outcomes Res. 2010;2(1):87–96.

    PubMed  CAS  Google Scholar 

  81. Hsu P, Federico C, Krajden M, Yoshida E, Bremner K, Anderson F, et al. Health utilities and psychometric quality of life in patients with early- and late-stage hepatitis C virus infection. J Gastroenterol Hepatol. 2012;27(1):149–57.

    Article  PubMed  Google Scholar 

  82. John-Baptiste A, Tomlinson G, Hsu P, Krajden M, Heathcote E, Laporte A, et al. Sustained responders have better quality of life and productivity compared with treatment failures long after antiviral therapy for hepatitis C. Am J Gastroenterol. 2009;104:2439–48.

    Article  PubMed  CAS  Google Scholar 

  83. Khokhar O, Lewis J. Reasons why patients infected with chronic hepatitis C virus choose to defer treatment: do they alter their decision with time? Dig Dis Sci. 2007;52(5):1168–76.

    Article  PubMed  Google Scholar 

  84. Liao C-C, Su T-C, Sung F-C, Chou W-H, Chen T-L. Does hepatitis C virus infection increase risk for stroke? A population-based cohort study. PLoS One. 2012;7(2):e31527.

    Article  PubMed  CAS  Google Scholar 

  85. Strauss E. Barriers to care of chronic hepatitis patients in Latin America. Arch Med Res. 2007;38(6):711–5.

    Article  PubMed  Google Scholar 

  86. Taylor-Young P, Hildebrandt E. The multidimensional burden of hepatitis C and its treatment: a case study. Gastroenterol Nurs. 2009;32(3):180–7.

    Article  PubMed  Google Scholar 

  87. Bonkovsky H, Woolley J. Reduction of health-related quality of life in chronic hepatitis C and improvement with interferon therapy. The Consensus Interferon Study Group. Hepatology. 1999;29(1):264–70.

    Article  PubMed  CAS  Google Scholar 

  88. Ware J, Bayliss M, Mannocchia M, Davis G. Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group. Hepatology. 1999;30(2):550–5.

    Article  PubMed  Google Scholar 

  89. Liu S, Cipriano L, Holodniy M, Owens D, Goldhaber-Fiebert J. New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis. Ann Intern Med. 2012;156:279–90.

    Article  PubMed  Google Scholar 

  90. Cammà C, Petta S, Enea M, Bruno R, Bronte F, Capursi V, et al. Cost-effectiveness of boceprevir or telaprevir for untreated patients with genotype 1 chronic hepatitis C. Hepatology. 2012;56(3):850–60.

    Article  PubMed  Google Scholar 

  91. Elbasha E, Chhatwal J, Ferrante S, El Khoury A, Laires P. Cost-effectiveness analysis of boceprevir for the treatment of chronic hepatitis C virus genotype 1 infection in Portugal. Appl Health Econ Health Policy. 2013;11(1):65–78.

    Article  PubMed  Google Scholar 

  92. Thorlund K, Druyts E, El Khoury A, Mills E. Budget impact analysis of boceprevir and telaprevir for the treatment of hepatitis C genotype I infection. Clinicoecon Outcomes Res. 2012;4:349–59.

    PubMed  Google Scholar 

  93. A study of mericitabine in combination with telaprevir and Pegasys/Copegus in patients with chronic hepatitis C. 2011 (July 5, 2012). http://clinicaltrials.gov/ct2/show/NCT01482390?term=mericitabine&rank=1. Cited 16 July 2012.

  94. Jacobson I, McHutchison J, Dusheiko G, Di Bisceglie A, Rajender Reddy K, Bzowej N, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;364(25):2405–16.

    Article  PubMed  CAS  Google Scholar 

  95. Sherman K, Flamm S, Afdhal N, Nelson D, Sulkowski M, Everson G, et al. Response-guided telaprevir combination treatment for hepatitis C virus infection. N Engl J Med. 2011;365(11):1014–24.

    Article  PubMed  CAS  Google Scholar 

  96. Zeuzem S, Andreone P, Pol S, Lawitz E, Diago M, Roberts S, et al. Telaprevir for retreatment of HCV infection. N Engl J Med. 2011;364(25):2417–28.

    Article  PubMed  CAS  Google Scholar 

  97. McHutchison J, Manns M, Muir A, Terrault N, Jacobson I, Afdhal N, et al. Telaprevir for previously treated chronic HCV infection. N Engl J Med. 2010;362(14):1292–303.

    Article  PubMed  CAS  Google Scholar 

  98. Bacon B, Gordon S, Lawitz E, Marcellin P, Vierling J, Zeuzem S, et al. Boceprevir for previously treated chronic HCV genotype 1 infection. N Engl J Med. 2011;364(13):1207–17.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

No funding was received for this manuscript and no writing assistance was utilized. The authors have no relevant disclosures related to this work. SJT, JB, and JAP contributed equally to the design, analysis, and preparation of the manuscript. JB is guarantor for the overall content of the manuscript.

Author information

Authors and Affiliations

  1. School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 205 Kapoor Hall, Buffalo, NY, 14214, USA

    Stuart J. Turner, Jack Brown & Joseph A. Paladino

  2. School of Public Health, University at Buffalo, Buffalo, NY, USA

    Jack Brown

  3. CPL Associates, Buffalo, NY, USA

    Joseph A. Paladino

Authors
  1. Stuart J. Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jack Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph A. Paladino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jack Brown.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turner, S.J., Brown, J. & Paladino, J.A. Protease Inhibitors for Hepatitis C: Economic Implications. PharmacoEconomics 31, 739–751 (2013). https://doi.org/10.1007/s40273-013-0073-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-013-0073-2

Keywords

Search

Navigation