Cost Effectiveness of Direct-Acting Antiviral Therapy for Treatment-Naive Patients With Chronic HCV Genotype 1 Infection in the Veterans Health Administration

Clinical Gastroenterology and Hepatology
Volume 11, Issue 11 , Pages 1503-1510, November 2013

Kee Chan, Mai Ngan Lai, Erik J. Groessl, Amresh D. Hanchate, John B. Wong, Jack A. Clark,  Steven M. Asch, Allen L. Gifford, Samuel B. Ho, 

published online 24 May 2013.

Abstract

Background & Aims

The Veterans Health Administration (VHA) is the largest single provider of care for hepatitis C virus (HCV) infection in the United States. We analyzed the cost effectiveness of treatment with the HCV protease inhibitors boceprevir and telaprevir in a defined managed care population of 102,851 patients with untreated chronic genotype 1 infection.

Methods

We used a decision-analytic Markov model to examine 4 strategies: standard dual-therapy with pegylated interferon-alfa and ribavirin (PR), the combination of boceprevir and PR triple therapy, the combination of telaprevir and PR, or no antiviral treatment. A sensitivity analysis was performed. Sources of data included published rates of disease progression, the census bureau, and VHA pharmacy and hospitalization cost databases.

Results

The estimated costs for treating each patient were $8000 for PR, $31,300 for boceprevir and PR, and $41,700 for telaprevir and PR. Assuming VHA treatment rates of 22% and optimal rates of sustained virologic response, PR, boceprevir and PR, and telaprevir and PR would reduce relative liver-related deaths by 5.2%, 10.9%, and 11.5%, respectively. Increasing treatment rates to 50% would reduce liver-related deaths by 12%, 24.7%, and 26.1%, respectively. The incremental cost-effectiveness ratios were $29,184/quality-adjusted life-years for boceprevir and PR and $44,247/quality-adjusted life-years for telaprevir and PR vs only PR. With the current 22% treatment rate, total system-wide costs to adopt boceprevir and PR or telaprevir and PR would range from $708 to $943 million.

Conclusions

Despite substantial up-front costs of treating HCV-infected patients in the VHA with PR, or telaprevir and PR, each regimen improves quality of life and extends life expectancy by reducing liver-related morbidity and mortality, and should be cost effective. Further efforts to expand access to direct-acting antiviral therapy are warranted.

Keywords: Liver Disease, Cirrhosis, Prevention, Health Care Costs

Abbreviations used in this paper: boc, boceprevir, DAA, direct-acting antiviral, HCC, hepatocellular carcinoma, HCV, hepatitis C virus, ICER, incremental cost-effectiveness ratio, IL, interleukin, PR, pegylated interferon-alfa and ribavirin, QALY, quality-adjusted life-year, SVR, sustained virologic response, tel, telaprevir, VHA, Veterans Health Administration

Conflicts of interest This author discloses the following: Samuel Ho has received research and grant support from Genetech, Inc, Vital Therapies, Inc, and Aspire Bariatrics, Inc; and has received expert panel fees from Roche Pharmaceuticals, Inc. The remaining authors disclose no conflicts.

Funding Supported by the Department of Veterans Affairs Health Services Research and Development Quality Enhancement Research Initiative (RRP 10-228).

PII: S1542-3565(13)00705-2

doi:10.1016/j.cgh.2013.05.014

© 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

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