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A Cost-Effectiveness Analysis of Shortened Direct-Acting Antiviral Treatment in Genotype 1 Noncirrhotic Treatment-Naive Patients With Chronic Hepatitis C Virus

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A Cost-Effectiveness Analysis of Shortened Direct-Acting Antiviral Treatment in Genotype 1 Noncirrhotic Treatment-Naive Patients With Chronic Hepatitis C Virus. / Fawsitt, Christopher; Vickerman, Peter; Cooke, Graham S; Welton, Nicky; STOP-HCV Consortium.

In: Value in Health, 17.05.2019.

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@article{b8fa8f316b834348bdd79a454a65cb43,
title = "A Cost-Effectiveness Analysis of Shortened Direct-Acting Antiviral Treatment in Genotype 1 Noncirrhotic Treatment-Naive Patients With Chronic Hepatitis C Virus",
abstract = "Objectives: Direct-acting antivirals (DAAs) are successful in curing hepatitis C virus (HCV) in over 95{\%} of patients treated for 12 weeks. DAAs are expensive, and shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. We evaluated the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 non-cirrhotic treatment-na{\"i}ve patients.Methods: Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare three unstratified shortened treatment durations (eight, six, and four weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were retreated with a 12-week treatment regimen. Parameter inputs were taken from published studies.Results: Eight weeks treatment duration had an expected incremental net monetary benefit (INMB) of £7,737 (95{\%} CI £3,242 to £11,819) versus standard 12 weeks treatment, per 1,000 patients. Six weeks treatment had a positive INMB, although some uncertainty was observed. The probability that eight and six weeks treatment was most cost-effective was 56{\%} and 25{\%}, respectively, while four weeks treatment was 17{\%}. Results were generally robust to sensitivity analyses, including a threshold analysis that showed eight weeks treatment was most cost-effective at all drug prices below £40,000 per 12-week course.Conclusions: Shortening treatments licensed for 12 weeks to eight weeks is cost-effective in genotype 1 non-cirrhotic treatment-na{\"i}ve patients. There was considerable uncertainty in the estimates for six and four weeks treatment, with some indication that six weeks treatment may be cost-effective.",
keywords = "cost effectiveness, direct-acting antivirals, hepatitis C virus, shortened treatment duration",
author = "Christopher Fawsitt and Peter Vickerman and Cooke, {Graham S} and Nicky Welton and {STOP-HCV Consortium}",
year = "2019",
month = "5",
day = "17",
doi = "10.1016/j.jval.2018.12.011",
language = "English",
journal = "Value in Health",
issn = "1098-3015",
publisher = "Elsevier Inc.",

}

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TY - JOUR

T1 - A Cost-Effectiveness Analysis of Shortened Direct-Acting Antiviral Treatment in Genotype 1 Noncirrhotic Treatment-Naive Patients With Chronic Hepatitis C Virus

AU - Fawsitt, Christopher

AU - Vickerman, Peter

AU - Cooke, Graham S

AU - Welton, Nicky

AU - STOP-HCV Consortium

PY - 2019/5/17

Y1 - 2019/5/17

N2 - Objectives: Direct-acting antivirals (DAAs) are successful in curing hepatitis C virus (HCV) in over 95% of patients treated for 12 weeks. DAAs are expensive, and shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. We evaluated the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 non-cirrhotic treatment-naïve patients.Methods: Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare three unstratified shortened treatment durations (eight, six, and four weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were retreated with a 12-week treatment regimen. Parameter inputs were taken from published studies.Results: Eight weeks treatment duration had an expected incremental net monetary benefit (INMB) of £7,737 (95% CI £3,242 to £11,819) versus standard 12 weeks treatment, per 1,000 patients. Six weeks treatment had a positive INMB, although some uncertainty was observed. The probability that eight and six weeks treatment was most cost-effective was 56% and 25%, respectively, while four weeks treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed eight weeks treatment was most cost-effective at all drug prices below £40,000 per 12-week course.Conclusions: Shortening treatments licensed for 12 weeks to eight weeks is cost-effective in genotype 1 non-cirrhotic treatment-naïve patients. There was considerable uncertainty in the estimates for six and four weeks treatment, with some indication that six weeks treatment may be cost-effective.

AB - Objectives: Direct-acting antivirals (DAAs) are successful in curing hepatitis C virus (HCV) in over 95% of patients treated for 12 weeks. DAAs are expensive, and shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. We evaluated the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 non-cirrhotic treatment-naïve patients.Methods: Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare three unstratified shortened treatment durations (eight, six, and four weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were retreated with a 12-week treatment regimen. Parameter inputs were taken from published studies.Results: Eight weeks treatment duration had an expected incremental net monetary benefit (INMB) of £7,737 (95% CI £3,242 to £11,819) versus standard 12 weeks treatment, per 1,000 patients. Six weeks treatment had a positive INMB, although some uncertainty was observed. The probability that eight and six weeks treatment was most cost-effective was 56% and 25%, respectively, while four weeks treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed eight weeks treatment was most cost-effective at all drug prices below £40,000 per 12-week course.Conclusions: Shortening treatments licensed for 12 weeks to eight weeks is cost-effective in genotype 1 non-cirrhotic treatment-naïve patients. There was considerable uncertainty in the estimates for six and four weeks treatment, with some indication that six weeks treatment may be cost-effective.

KW - cost effectiveness

KW - direct-acting antivirals

KW - hepatitis C virus

KW - shortened treatment duration

U2 - 10.1016/j.jval.2018.12.011

DO - 10.1016/j.jval.2018.12.011

M3 - Article

JO - Value in Health

T2 - Value in Health

JF - Value in Health

SN - 1098-3015

ER -