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Cost Effectiveness of Daclatasvir/Asunaprevir Versus Peginterferon/Ribavirin and Protease Inhibitors for the Treatment of Hepatitis c Genotype 1b Naïve Patients in Chile.

Vargas CL, Espinoza MA, Giglio A, Soza A - PLoS ONE (2015)

Bottom Line: In association, they are more effective and safer than previous available treatments, but more expensive.Although the results are sensitive to certain parameters, the ICER did not increase above the suggested threshold of 1 GDP per capita.These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system.

View Article: PubMed Central - PubMed

Affiliation: Centre of Clinical Research, Health Technology Assessment Unit, Pontificia Universidad Catolica de Chile, Santiago, Chile.

ABSTRACT

Introduction: Daclatasvir and Asunaprevir (DCV/ASV) have recently been approved for the treatment of chronic hepatitis C virus infection. In association, they are more effective and safer than previous available treatments, but more expensive. It is unclear if paying for the additional costs is an efficient strategy considering limited resources.

Methods: A Markov model was built to estimate the expected costs in Chilean pesos (CL$) and converted to US dollars (US$) and benefits in quality adjusted life years (QALYs) in a hypothetic cohort of naive patients receiving DCV/ASV compared to protease inhibitors (PIs) and Peginterferon plus Ribavirin (PR). Efficacy was obtained from a mixed-treatment comparison study and costs were estimated from local sources. Utilities were obtained applying the EQ-5D survey to local patients and then valued with the Chilean tariff. A time horizon of 46 years and a discount rate of 3% for costs and outcomes was considered. The ICERs were estimated for a range of DCV/ASV prices. Deterministic and probabilistic sensitivity analyses were performed.

Results: PIs were extendedly dominated by DCV/ASV. The ICER of DCV/ASV compared to PR was US$ 16,635/QALY at a total treatment price of US$ 77,419; US$11,581 /QALY at a price of US$ 58,065; US$ 6,375/QALY at a price of US$ 38,710; and US$ 1,364 /QALY at a price of US$ 19,355. The probability of cost-effectiveness at a price of US$ 38,710 was 91.6% while there is a 21.43% probability that DCV/ASV dominates PR if the total treatment price was US$ 19,355. Although the results are sensitive to certain parameters, the ICER did not increase above the suggested threshold of 1 GDP per capita.

Conclusions: DCV/ASV can be considered cost-effective at any price of the range studied. These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system.

No MeSH data available.


Related in: MedlinePlus

Deterministic sensitivity analysis tornado graph: Tornado graph showing the variation of the ICER when parameters are varied independently.The parameters with highest impact on the ICER are shown on the graph: transition probability from F4 to SVR when the treatment is DCV/ASV and PR, transition probability from F2-F3, transition probability from f4 to DC, QALY of the SVR-F4 and SVR-F3 states, QALY of the F2, F3 and F4 state, treatment discontinuation at week 4 for PR and DCV/ASV.
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pone.0141660.g002: Deterministic sensitivity analysis tornado graph: Tornado graph showing the variation of the ICER when parameters are varied independently.The parameters with highest impact on the ICER are shown on the graph: transition probability from F4 to SVR when the treatment is DCV/ASV and PR, transition probability from F2-F3, transition probability from f4 to DC, QALY of the SVR-F4 and SVR-F3 states, QALY of the F2, F3 and F4 state, treatment discontinuation at week 4 for PR and DCV/ASV.

Mentions: A one-way sensitivity analysis was performed for transition probabilities, QALYs, discount rates, disease related costs, treatment costs and other variables considering the base case scenario as a benchmark. The objective of this analysis was to determine the variation of the ICER of the base case scenario when parameters vary independently. The results of these variations are presented on the tornado graph (Fig 2). The biggest impact on the ICER occurred when the discount rate was modified to 6% and 0%, reaching values of US$ 10,933 and US$ 3,952 per additional QALY respectively. The rest of the parameters were modified by ± 30% in relative terms. A 30% increase of the transition probability from F4 to the state of SVR when treated with DCV/ASV (equivalent to a SVR rate of 100%), reduced the ICER to US$ 5,662 per additional QALY, whereas a reduction of 30% produced and increase of the ICER up to US$ 9,839 per additional QALY. Likewise, the same variation in the transition probability for PR changed the ICER from US$ 5,893 to US$ 8,579 per QALY gained.


Cost Effectiveness of Daclatasvir/Asunaprevir Versus Peginterferon/Ribavirin and Protease Inhibitors for the Treatment of Hepatitis c Genotype 1b Naïve Patients in Chile.

Vargas CL, Espinoza MA, Giglio A, Soza A - PLoS ONE (2015)

Deterministic sensitivity analysis tornado graph: Tornado graph showing the variation of the ICER when parameters are varied independently.The parameters with highest impact on the ICER are shown on the graph: transition probability from F4 to SVR when the treatment is DCV/ASV and PR, transition probability from F2-F3, transition probability from f4 to DC, QALY of the SVR-F4 and SVR-F3 states, QALY of the F2, F3 and F4 state, treatment discontinuation at week 4 for PR and DCV/ASV.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4636244&req=5

pone.0141660.g002: Deterministic sensitivity analysis tornado graph: Tornado graph showing the variation of the ICER when parameters are varied independently.The parameters with highest impact on the ICER are shown on the graph: transition probability from F4 to SVR when the treatment is DCV/ASV and PR, transition probability from F2-F3, transition probability from f4 to DC, QALY of the SVR-F4 and SVR-F3 states, QALY of the F2, F3 and F4 state, treatment discontinuation at week 4 for PR and DCV/ASV.
Mentions: A one-way sensitivity analysis was performed for transition probabilities, QALYs, discount rates, disease related costs, treatment costs and other variables considering the base case scenario as a benchmark. The objective of this analysis was to determine the variation of the ICER of the base case scenario when parameters vary independently. The results of these variations are presented on the tornado graph (Fig 2). The biggest impact on the ICER occurred when the discount rate was modified to 6% and 0%, reaching values of US$ 10,933 and US$ 3,952 per additional QALY respectively. The rest of the parameters were modified by ± 30% in relative terms. A 30% increase of the transition probability from F4 to the state of SVR when treated with DCV/ASV (equivalent to a SVR rate of 100%), reduced the ICER to US$ 5,662 per additional QALY, whereas a reduction of 30% produced and increase of the ICER up to US$ 9,839 per additional QALY. Likewise, the same variation in the transition probability for PR changed the ICER from US$ 5,893 to US$ 8,579 per QALY gained.

Bottom Line: In association, they are more effective and safer than previous available treatments, but more expensive.Although the results are sensitive to certain parameters, the ICER did not increase above the suggested threshold of 1 GDP per capita.These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system.

View Article: PubMed Central - PubMed

Affiliation: Centre of Clinical Research, Health Technology Assessment Unit, Pontificia Universidad Catolica de Chile, Santiago, Chile.

ABSTRACT

Introduction: Daclatasvir and Asunaprevir (DCV/ASV) have recently been approved for the treatment of chronic hepatitis C virus infection. In association, they are more effective and safer than previous available treatments, but more expensive. It is unclear if paying for the additional costs is an efficient strategy considering limited resources.

Methods: A Markov model was built to estimate the expected costs in Chilean pesos (CL$) and converted to US dollars (US$) and benefits in quality adjusted life years (QALYs) in a hypothetic cohort of naive patients receiving DCV/ASV compared to protease inhibitors (PIs) and Peginterferon plus Ribavirin (PR). Efficacy was obtained from a mixed-treatment comparison study and costs were estimated from local sources. Utilities were obtained applying the EQ-5D survey to local patients and then valued with the Chilean tariff. A time horizon of 46 years and a discount rate of 3% for costs and outcomes was considered. The ICERs were estimated for a range of DCV/ASV prices. Deterministic and probabilistic sensitivity analyses were performed.

Results: PIs were extendedly dominated by DCV/ASV. The ICER of DCV/ASV compared to PR was US$ 16,635/QALY at a total treatment price of US$ 77,419; US$11,581 /QALY at a price of US$ 58,065; US$ 6,375/QALY at a price of US$ 38,710; and US$ 1,364 /QALY at a price of US$ 19,355. The probability of cost-effectiveness at a price of US$ 38,710 was 91.6% while there is a 21.43% probability that DCV/ASV dominates PR if the total treatment price was US$ 19,355. Although the results are sensitive to certain parameters, the ICER did not increase above the suggested threshold of 1 GDP per capita.

Conclusions: DCV/ASV can be considered cost-effective at any price of the range studied. These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system.

No MeSH data available.


Related in: MedlinePlus