The Veterans Health Administration (VHA) is the largest single provider of hepatitis C (HCV) care in the United States. As of 2010 there were 165,005 patients with HCV viremia in VHA care, including 129,164 patients (103,331 genotype 1) that have never received any antiviral treatment. The newly approved direct antiviral agents (DAA), Boceprevir (Boc) and Telaprevir (Tel), have significantly improved SVR rates for genotype 1 patients, although are also significantly more expensive compared to current therapy.
The aim of this study was to analyze the cost-effectiveness of newly approved DAA drugs in a defined managed care population of 102,851 patients with untreated chronic HCV genotype 1 infection.
A Markov model using transition probabilities between health states was developed to simulate the lifetime progression of HCV and the clinical impacts of DAA in the current cohort of 102,851 genotype 1 treatment patients.
A decision-analytic Markov model examined 4 strategies: (1) Standard dual therapy pegylated interferon alfa and ribavirin (PR), (2) Boc/PR triple therapy (3) Tel/PR triple therapy, and (4) no antiviral treatment and incuded sensitivity analysis. Data sources included published natural history progression rates, census bureau data, and current VHA pharmacy and hospitalization costs.
Estimated antiviral treatment costs associated with PR alone, Boc/PR, and Tel/PR were $8000, $ 31,300 and $ 41,700 per patient, respectively. Assuming 22% VHA treatment rates and optimal SVR results, PR, Boc/PR, and Tel/PR would reduce relative liver-related deaths by 5.0%,10.4% , and 11.0% respectively. Increasing treatment rates to 50% would reduce liver-related death by 11%, 23.7% and 25.0%, respectively. The incremental cost-effectiveness ratios were $29,184/QALY for Boc/PR and $44,247/QALY for Tel/PR versus standard PR. With the current 22% treatment rate, total system-wide costs to adopt Boc/PR or Tel/PR would range from $708 million to $943 million.
Despite substantial upfront costs for Boc/PR, and Tel/PR, both therapies improve quality of life and extend life expectancy due to reduced liver-related morbidity and mortality, and both therapies should be cost effective within the VHA system. Further efforts to expand access to DAA therapy are warranted. Increasing treatment rates to 50% and use of DAA therapies with optimal SVR rates leads to significant decrease in the number of patients expected to develop liver complications and liver related death. These data illustrate the implications of increasing antiviral treatment rates and optimizing adherence in the VHA system.
- Chan K, Lai MN, Groessl E, Hanchate A, Hernandez L, Wong J, Clark J, Asch S, Gifford A, Ho SB. Long term Clinical Impact of Direct Antiviral Agent (DAA) therapy for untreated Chronic Hepatitis C genotype 1 infection in the Veterans Health Administration. [Abstract]. Hepatology. 2011 Nov 1; 54(S1):437A.
- Chan K, Lai MN, Groessl E, Hanchate A, Wong JB, Clark JA, Asch SM, Gifford AL, Ho SB. Potential Costs Associated with New Direct-Acting Antivirals (DAAs) therapy for untreated Chronic Hepatitis C genotype 1 infection in the Veterans Health Administration. Poster session presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 16; National Harbor, MD.
- Chan K, Groessl EJ, Hanchate AD, Ho SB. Potential Costs Associated with New Direct-Antiviral Agent (DAA) therapy for untreated Chronic Hepatitis C genotype 1 infection in the Veterans Health Administration. Paper presented at: International Society for Pharmacoeconomics and Outcomes Research Western Pharmacoeconomics Biennial Conference; 2011 Nov 5; Madrid, Spain.
- Chan K, Lai MN, Groessl E, Hanchate A, Hernandez L, Wong J, Clark J, Asch S, Gifford A, Ho SB. Long term Clinical Impact of Direct Antiviral Agent (DAA) therapy for untreated Chronic Hepatitis C genotype 1 infection in the Veterans Health Administration. Presented at: American Association for the Study of Liver Diseases Annual Meeting; 2011 Nov 4; San Francisco, CA.