Background The standard care for chronic hepatitis C is a double treatment that consists of associating ribavirin (RBV) and peginterferon (pegINF) α-2a/2b. New therapeutic agents telaprevir and boceprevir have recently been approved in Europe in combination with pegINF and RBV for the treatment of patients with genotype 1 HCV who have not been treated previously or when standard treatment has failed. They are serine protease inhibitors and belong to a new class of drugs: direct acting antivirals (DDAs).
Purpose To evaluate the pharmacoeconomic aspects of triple therapy with RBV, pegIFN and telaprevir or boceprevir, as reported in the literature.
Materials and Methods Cut-off guidelines have been established to quantify the suitability of new treatments based on the cost of treatment per quality-adjusted life year (QALY). The impact of using the new drugs was assessed on a hypothetical group of 14,000 patients infected with HCV (genotype 1). Unfortunately the price of the new drugs has not yet been negotiated in Italy; this represents a limit on the evaluation. The results are expressed in terms of Incremental cost-effectiveness ratios (ICERs).
Results The cost was estimated at €31,000/patient, 236.5 M€ over a period of 30 years. The ICER calculated to 20 years was €29.485/QALY while at 30 years was €18.291/QALY. Investment in these new molecules is favourable from a time horizon of 20 years.
Conclusions Boceprevir and telaprevir with standard treatment are cost effective considering the lifetime incidence of liver complications, quality-adjusted life years and the incremental cost-effectiveness ratio. The cost effectiveness depends on the adherence to the treatment; it could be improved if the diagnostic and therapeutic pathways were optimised.
No conflict of interest.
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