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

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

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Publication Type:: Journal Article
Citation:: PLoS ONE, 2015, 10 (11)
Issue Date:: 2015-11-06

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Field	Value	Language
dc.contributor.author	Vargas, CL https://orcid.org/0000-0002-8667-1926	en_US
dc.contributor.author	Espinoza, MA	en_US
dc.contributor.author	Giglio, A	en_US
dc.contributor.author	Soza, A	en_US
dc.date.available	2015-10-12	en_US
dc.date.issued	2015-11-06	en_US
dc.identifier.citation	PLoS ONE, 2015, 10 (11)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/134594
dc.description.abstract	© 2015 Vargas et al. 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.	en_US
dc.relation.ispartof	PLoS ONE	en_US
dc.relation.isbasedon	10.1371/journal.pone.0141660	en_US
dc.subject.classification	General Science & Technology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Hepacivirus	en_US
dc.subject.mesh	Hepatitis C, Chronic	en_US
dc.subject.mesh	Polyethylene Glycols	en_US
dc.subject.mesh	Sulfonamides	en_US
dc.subject.mesh	Imidazoles	en_US
dc.subject.mesh	Isoquinolines	en_US
dc.subject.mesh	Interferon-alpha	en_US
dc.subject.mesh	Recombinant Proteins	en_US
dc.subject.mesh	Ribavirin	en_US
dc.subject.mesh	Protease Inhibitors	en_US
dc.subject.mesh	Antiviral Agents	en_US
dc.subject.mesh	Drug Therapy, Combination	en_US
dc.subject.mesh	Probability	en_US
dc.subject.mesh	Genotype	en_US
dc.subject.mesh	Quality of Life	en_US
dc.subject.mesh	Cost-Benefit Analysis	en_US
dc.subject.mesh	Chile	en_US
dc.title	Cost effectiveness of daclatasvir/asunaprevir versus peginterferon/ribavirin and protease inhibitors for the treatment of hepatitis c genotype 1b Naïve patients in Chile	en_US
dc.type	Journal Article
utslib.citation.volume	11	en_US
utslib.citation.volume	10	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
utslib.copyright.status	open_access
pubs.issue	11	en_US
pubs.publication-status	Published	en_US
pubs.volume	10	en_US

Abstract:

© 2015 Vargas et al. 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.

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