The cost-effectiveness of boceprevir for hepatitis C

Abstract

Hepatitis C virus (HCV) infection is costly to treat and, has high morbidity and mortality. The addition of new protease inhibitors (i.e., boceprevir, telaprevir), to the standard dual therapy with pegylated interferon-α and ribavirin, for the treatment of HCV infection has demonstrated superior efficacy with shorter treatment duration, but at higher drug acquisition costs and incidence of adverse events. Robust economic data are required to inform healthcare decision for the optimal use of these expensive antiviral agents. Accordingly, this review will explore the clinical and economic aspects of boceprevir-based treatment strategies. Important considerations, challenges and gaps for future pharmacoeconomic research in this setting are highlighted.

Keywords::

• costs
• economic
• hepatitis C infection
• modeling
• protease inhibitors

Financial & competing interests disclosure

D Kong has sat on an advisory boards for Pfizer and Merck, Sharp & Dohme, and receives financial/travel support (unrelated to the current work) from Pfizer, Merck, Roche, Novartis, and Gilead Sciences. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Hepatitis C virus (HCV) infection complicates modern medical therapy, contributing to high morbidity and mortality and is costly to treat.

• Although the addition of protease inhibitors (PIs) to standard dual therapy has favorable efficacy, the cost of treatment using PIs remains a pivotal consideration for the management of HCV infection, especially within an environment of limited healthcare resources, underlining the need for assessing their health returns.

• There has been a marked increase in the number of economic studies on boceprevir-based treatment strategies over the last 2 years, with the majority of the analyses meeting the basic and important criteria for economic studies (i.e., the use of appropriate comparators, sources of input data, discount rates, and sensitivity analyses).

• Outlining the assumptions used in the Markov models of HCV infection is central to ensuring validity and comparability of the economic findings.

• Although these studies have limitations, available data suggest that boceprevir is cost-effective in treating HCV infections, particularly patients with advanced liver fibrosis.

• Head-to-head comparison of boceprevir and telaprevir for both clinical and economic outcomes is anticipated. Well-designed prospective clinical studies that take into account the economic considerations are needed to facilitate informed decisions with respect to the use of PIs such as boceprevir in HCV infection.