Cost-effectiveness of telaprevir in combination with pegylated interferon alpha and ribavirin in treatment-experienced chronic hepatitis C genotype 1 patients

Abstract

Background:

Telaprevir (TVR,T) and boceprevir (BOC,B) are direct-acting antivirals (DAAs) used for the treatment of chronic genotype 1 hepatitis C virus (HCV) infection. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV) compared with Peg-IFN alfa-2a and RBV (PR) alone or BOC plus Peg-IFN alfa-2b and RBV in treatment-experienced patients.

Methods:

A Markov cohort model of chronic genotype 1 HCV disease progression reflected the pathway of experienced patients retreated with DAA therapy. The population was stratified by previous response to treatment (i.e., previous relapsers, partial responders, and null responders). Sustained virologic response (SVR) rates were derived from a mixed-treatment comparison that included results from separate Phase III trials of TVR and BOC. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the NHS perspective. Costs and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were carried out by interleukin (IL)-28B genotype.

Results:

Higher costs and improved outcomes were associated with T/PR relative to PR alone for all experienced patients (ICER of £6079). T/PR was cost-effective for each sub-group population with high SVR advantage in relapsers (ICER of £2658 vs £7593 and £20,875 for partial and null responders). T/PR remained cost-effective regardless of IL-28B sub-type. Compared to B/PR, T/PR prolonged QALYs by 0.57 and reduced lifetime costs by £13,960 for relapsers. For partial responders T/PR was less costly but less efficacious than B/PR, equating to an ICER of £128,117 per QALY gained.

Limitations:

No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR.

Conclusion:

T/PR is cost-effective compared with PR alone in experienced patients regardless of treatment history and IL-28B genotype. Compared to B/PR, T/PR is always cost-saving but only more effective in relapsers.

Keywords::

• Cost-effectiveness analysis
• Chronic hepatitis C infection
• Previously treated patients
• Telaprevir
• Boceprevir

Transparency

Declaration of funding

This analysis was funded by Janssen Pharmaceuticals. The authors confirm that the paper is an accurate representation of the study results. Several authors are employees of the sponsor and were involved in the study design, data collection and analysis, interpretation of data, writing of the report, and the decision to submit the paper for publication.

Declaration of financial/other interests

S. Cure and FB are employees of OptumInsight, who received funding from Janssen Pharmaceuticals. SG, S Curtis, and SL are employees of Janssen Pharmaceuticals. JME Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose. GD has received consulting fees from Roche, Merck, and Janssen pharmaceuticals.

Acknowledgements

We thank Catherine Elliott (Gardiner-Caldwell Communications) for general editing/styling and co-ordination support, which was funded by Janssen Pharmaceuticals. Author contributions: S. Cure, F. Bianic, S. Gavart, and G. Dusheiko were involved in designing these analyses; S. Curtis, and S. Lee were involved in the collection, analysis, and interpretation of data; S. Cure and S. Lee wrote the first draft of the report, which was subsequently critically reviewed by all authors; all authors were involved in the decision to submit the paper for publication.