Resumo

BUTI, Maria et al. Cost-utility analysis of triple therapy with telaprevir in treatment-naïve hepatitis C patients. Farm Hosp. [online]. 2014, vol.38, n.5, pp.418-429. ISSN 2171-8695.  https://dx.doi.org/10.7399/FH.2014.38.5.7640.

Introduction: The prevalence of Hepatitis C (HCV) in Spain is 2,5%, with a high morbimortality rate. Triple therapy based on telaprevir plus peginterferon/ribavirin ([T/PR]) has demonstrated to be an effective approach in treatment-naïve G1-HCV patients. This analysis evaluated, through a Markov model, the incremental cost-effectiveness ratio of triple therapy compared to peginterferon/ribavirin ([PR]) alone in naive patients depending on fibrosis stage, from the Spanish Healthcare Authorities perspective. Methods: Efficacy results and adverse events incidence were based on the combined results of ADVANCE and OPTIMIZE studies. Adverse events and disease-related costs (€, 2014) were built up from panel expert opinion except from transplant and post-transplant costs, taken from published data. Drug costs were obtained from national databases and adjusted for the mandatory deduction. Outcomes and costs were both discounted at 3%/year. Results: The analysis shows higher costs and improved outcomes associated with [TR/PR] relative to [PR] alone, resulting ln an incremental cost-effectiveness ratio (ICER) of €18,288/ QALY for all the cohort, €14,152QALY for moderate fibrosis, €11,364QALY for bridging fibrosis, €15,929/QALY for cirrhosis. Over a lifetime period, the use of [T/PR] could avoid 12 cirrhosis and 4 liver transplants per 1,000 patients compared to [PR] alone. The probabilistic analysis, following 10,000 Montecarlo simulations, demonstrated the probability of an ICER below a €30,000/QALY gained threshold of 69%. At a willingness-to-pay of €30,000/QALY, [T/PR] could be considered as an efficient option compared with [PR] alone for treatment-naíve genotype 1 HCV patients, over a lifetime horizon.

Palavras-chave : Hepatitis C; Telaprevir; Genotype 1; Cost-effectiveness; Peginterferon alfa 2a; Ribavirine.

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