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

Figures & data

Figure 1. Markov model diagram. SVR, sustained virologic response; HCV, hepatitis C virus.

Table 1. Annual transition probabilities (TPs) used within the Markov model.

Initial health state transitioned from:	To:	Probability of transitioning (DSA ranges)
Mild fibrosis16	Moderate fibrosis	<35 years old: 0.015 (0.011–0.019); 36–45 years old: 0.023 (0.017–0.029); >45 years old: 0.053 (0.026–0.044)
Moderate fibrosis16	Cirrhosis	<35 years old: 0.021 (0.016–0.026); 36–45 years old: 0.032 (0.024–0.040); >45 years old: 0.048 (0.036–0.060)
Cirrhosis15	Decompensated cirrhosis	0.039 (0.029–0.049)
Cirrhosis15	HCC	0.014 (0.011–0.018)
Cirrhosis with SVR	HCC	0.014 (0.011–0.018)
Decompensated cirrhosis15	HCC	0.014 (0.011–0.018)
Decompensated cirrhosis15	Liver transplant	0.020 (0.015–0.025)
Decompensated cirrhosis15	Death	0.130 (0.098–0.163)
HCC	Liver transplant	0.040 (0.030–0.050)
HCC15	Death	0.43 (0.323–0.538)
Liver transplant15	Death	0.15 (0.113–0.188)
Post-liver transplant15	Death	0.057 (0.043–0.071)

HCC, hepatocellular carcinoma; SVR, sustained virologic response.

Table 2. Model inputs.

Base case inputs (DSA ranges)	Mild fibrosis	Moderate fibrosis	Cirrhosis	Decompensated cirrhosis	HCC	Liver transplant	Post-liver transplant
Patient characteristics9
Age at treatment: 30 years, %	63.6	32.7	3.7
Age at treatment: 40 years, %	43.4	40.6	16.0
Age at treatment: 50 years, %	30.8	43.3	25.9
Drug costs
PR alone	£7292	£7292	£7292
T/PR	£25,455	£25,455	£25,455
B/PR	£26,342	£26,342	£26,342
Treatment duration9
PR alone, weeks	36.2	36.2	36.2
T/PR, weeks
PR, weeks	26.9	26.9	26.9
TVR, weeks	10.7	10.7	10.7
B/PR
PR, weeks	31.1	31.1	31.1
BOC, weeks	27.1	27.1	27.1
Monitoring costs
PR alone	£972	£972	£1033
T/PR	£882	£882	£928
B/PR	£928	£928	£989
Adverse management costs
EPO	£1650*	£1650*	£1650*
Health state costs
Without treatment15	£175 (88–263)	£911 (455–1366)	£1445 (723–2169)
SVR following treatment15,16	£220 (110–329)	£268 (134–403)	£475 (237–712)
Advanced disease stages15	–	–	–	£11,583 (5791–17,374)	£10,321 (5161–15,482)	£46,720 (23,360–70,080)	£12,016 (6008–18,024)
Utilities9,15
Without treatment	0.77 (0.578–0.963)	0.66 (0.495–0.825)	0.55 (0.413 – 0.688)
PR alone	0.675	0.579	0.482
T/PR	0.682	0.585	0.487
B/PR	0.682	0.585	0.487
SVR following treatment	0.82 (0.615–1)	0.72 (0.540–0.900)	0.61 (0.458 – 0.763)
Advanced disease stages	–	–	–	0.45 (0.338–0.563)	0.45 (0.338–0.563)	0.45 (0.338–0.563)	0.67 (0.503–0.838)

PR, peginterferon/ribavirin; T/PR, telaprevir plus PR; B/PR, boceprevir plus PR; SVR, sustained virologic response; PI, protease inhibitor; HCC, hepatocellular carcinoma; TVR, telaprevir; BOC, boceprevir.

*183 units per week for 159 days.

Table 3. Sustained virological response (SVR) rates inputted into the model.

Patients with SVR, %^a (DSA ranges) Treatment regimens	Overall population	Disease severity			IL-28B genotype
		Mild fibrosis	Moderate fibrosis	Cirrhosis	CC	CT	TT
PR	42.9 (39.23–46.59)	45.6	47.5	32.9	63.6	25.0	23.1
T/PR	73.9 (67.6–79.7%)	81.3	75.0	61.6	90.0	70.6	72.7
B/PR^b	66.5 (59.1–73.9)	NA	NA	NA	NA	NA	NA

^aSVR rates were estimated by a meta-analysis9,10^,28–33.

^bSVR rates according to disease severity were not available for B/PR.

PR, peginterferon/ribavirin; T/PR, telaprevir plus PR; B/PR, boceprevir plus PR; IL-28B, interleukin-28B; NA, not applicable.

Table 4. Cost-effectiveness results: base case.

	T/PR	PR	B/PR	T/PR vs PR		T/PR vs B/PR
				Incremental costs and QALYS	ICER (cost per QALY gained)	Incremental costs and QALYS	ICER (cost per QALY gained)
Total costs	£35,347	£24,420	£38,105	£10,927	£12,733	−£2758	T/PR dominates
Total QALYs	13.89	13.03	13.68	0.86		0.20

PR, peginterferon/ribavirin; T/PR, telaprevir plus PR; B/PR, boceprevir plus PR; QALY, quality-adjusted life-year; ICER, incremental cost-effectiveness ratio.

Table 5. Cost-effectiveness results: sub-group analyses.

	T/PR	PR	B/PR	T/PR vs PR
				Incremental costs and QALYS	ICER (cost per QALY gained)
IL-28B genotype
CC
Total costs	£31,628	£19,631	£34,564	£11,997	£16,419
Total QALYs	14.33	13.60	14.11	0.73
CT
Total costs	£36,102	£28,554	£38,436	£7548	£5986
Total QALYs	13.80	12.54	13.64	1.26
TT
Total costs	£35,612	£29,998	£40,812	£6615	£4820
Total QALYs	13.86	12.48	13.36	1.37
Disease stage
Mild CHC
Total costs	£29,415	£15,444	NA	£13,971	£17,595
Total QALYs	16.17	15.38	NA	0.79
Moderate CHC
Total costs	£34,821	£24,638	NA	£10,182	£11,446
Total QALYs	13.74	12.85	NA	0.89
Cirrhosis
Total costs	£50,050	£41,843	NA	£8207	£9607
Total QALYs	9.45	8.59	NA	0.85

PR, peginterferon/ribavirin; T/PR, telaprevir plus PR; B/PR, boceprevir plus PR; IL-28B, interleukin-28B; QALY, quality-adjusted life-year; ICER, incremental cost-effectiveness ratio; CHC, chronic hepatitis C.

Figure 2. Tornado chart of cost per QALY gained for the T/PR regimen vs PR alone. PR, peginterferon/ribavirin; T/PR, telaprevir plus PR; SVR, sustained virologic response; SOC, standard of care; QALY, quality-adjusted life-year; ICER, incremental cost-effectiveness ratio.

Figure 3. Cost-effectiveness plane: cost per QALY (£/QALY) gained for the T/PR regimen vs PR alone. PR, peginterferon/ribavirin; T/PR, telaprevir plus PR; QALY, quality-adjusted life-year.

Figure 4. Cost-effectiveness acceptability curve based on the cost per QALY (£/QALY) gained for the T/PR regimen vs PR alone and vs B/PR. PR, peginterferon/ribavirin; B/PR, boceprevir plus PR; T/PR, telaprevir plus PR; QALY, quality-adjusted life-year.

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