Cost-effectiveness of protease inhibitor based regimens for chronic hepatitis C: a systematic review of published literature

Abstract

The treatment of chronic hepatitis C has experienced a substantial progress with the arrival of Boceprevir and Telaprevir due to the significant increase in sustained viral response. Given the high cost, their approval has been followed by great deal of pharmacoeconomic literature analysing their efficiency. A systematic review of this literature was carried out, evaluating both its results and the methodology employed. 54 references were revised including 11 studies, 6 on naive populations, 3 on pre-treated patients and 2 in both of them. As the clinical heterogeneity of patients influenced sustained viral response, therapy regimens were assessed conditioned to the interleukin 28B polymorphism, the early response to treatment and the level of fibrosis, among other variables. Most of the options evaluated on a naive population presented ICERs below the acceptability threshold. The same occurred in the pre-treated population, where the subgroups analysis is perceived as a methodological limitation.

Keywords::

• boceprevir
• chronic hepatitis C
• cost-effectiveness
• disease-related costs
• pegylated interferon
• protease inhibitors
• ribavirin
• telaprevir
• treatment burden

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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

Key issues

• The introduction of protease inhibitors has led to a considerable therapeutic advance in the treatment of genotype 1 chronic hepatitis C (CHC).

• Their use entails a significant adverse effect profile, an increase in the acquisition costs and uncertainty regarding potential future cross-resistances and their repercussions.

• Patient adherence to treatment is crucial to the efficient use of protease inhibitors and could be influenced by the adverse effect profile and pill burden.

• The incremental cost-effectiveness ratios estimated for the majority of strategies fall within the established ranges of acceptability both for naive and pretreated patients.

• The selection of patients and therapeutic strategies on the basis of the IL28B polymorphism, level of fibrosis and rapid viral response could improve treatment efficiency.

• Regardless of incremental cost-effectiveness ratio values, the economic burden of facing the cost of therapies and the resulting impact on health care budgets could jeopardize access to treatments.

• The simulation models allow long-term analysis of costs and health outcomes, especially interesting in diseases like CHC where the costs accrued due to the treatment are concentrated over 24–48 weeks. The methodology of the models introduces parameter uncertainties that would benefit from the long-term follow-up of cohorts in which the natural history and complications of hepatitis C virus infection are analyzed.

• The emergence of boceprevir and telaprevir seems to only be the beginning of a great change in the therapy scenario of CHC.

Notes