Objectives: To conduct a cost-effectiveness analysis of two planning strategies of the second-generation direct-acting antiviral interferon-free regimens for the treatment of chronic hepatitis C virus infection. Methods: A lifetime multicohort model comprised 8125 real-life patients enrolled in the PITER (Italian platform for the study of viral hepatitis) registry, implemented by the ISS (Istituto Superiore di Sanità). Two treatment planning strategies were compared: 1) policy 1—treat all patients regardless of the stage of fibrosis (F0–F4) with second-generation direct-acting antivirals and 2) policy 2—treat patients at F3/F4 stage and those who are prioritized by the scientific guidelines first, and the remaining patients when they reach the F3 stage. Clinical outcomes and costs were evaluated by using a lifetime horizon Markov model and adopting the third-party payer perspective. Health outcomes were expressed in terms of quality-adjusted life-years (QALYs). A sensitivity analysis was run to explore first- and second-order uncertainty and heterogeneity. An expected value of perfect information analysis was also conducted. Results: Policy 1 exhibits an incremental cost-effectiveness ratio of €8,775/QALY gained and remains less than €30,000/QALY in 94% of realizations produced by the Monte-Carlo simulation. Such a proportion increases to 97% when adopting a threshold of €40,000/QALY gained. Conclusions: Moving from the urgency criterion to evidence-based escalating strategies when prioritizing the access to new anti–hepatitis C virus treatments is a good investment in health, whose affordability should be explored through context-specific budget impact analyses.

Ruggeri, M., Coretti, S., Romano, F., Kondili, L. A., Vella, S., Cicchetti, A., Economic Evaluation of the Hepatitis C Virus Treatment Extension to Early-Stage Fibrosis Patients: Evidence from the PITER Real-World Cohort, <<VALUE IN HEALTH>>, 2018; 21 (7): 783-791. [doi:10.1016/j.jval.2017.10.021] [http://hdl.handle.net/10807/172952]

Economic Evaluation of the Hepatitis C Virus Treatment Extension to Early-Stage Fibrosis Patients: Evidence from the PITER Real-World Cohort

Ruggeri, Matteo;Coretti, Silvia;Romano, Federica;Vella, Stefano;Cicchetti, Americo
2018

Abstract

Objectives: To conduct a cost-effectiveness analysis of two planning strategies of the second-generation direct-acting antiviral interferon-free regimens for the treatment of chronic hepatitis C virus infection. Methods: A lifetime multicohort model comprised 8125 real-life patients enrolled in the PITER (Italian platform for the study of viral hepatitis) registry, implemented by the ISS (Istituto Superiore di Sanità). Two treatment planning strategies were compared: 1) policy 1—treat all patients regardless of the stage of fibrosis (F0–F4) with second-generation direct-acting antivirals and 2) policy 2—treat patients at F3/F4 stage and those who are prioritized by the scientific guidelines first, and the remaining patients when they reach the F3 stage. Clinical outcomes and costs were evaluated by using a lifetime horizon Markov model and adopting the third-party payer perspective. Health outcomes were expressed in terms of quality-adjusted life-years (QALYs). A sensitivity analysis was run to explore first- and second-order uncertainty and heterogeneity. An expected value of perfect information analysis was also conducted. Results: Policy 1 exhibits an incremental cost-effectiveness ratio of €8,775/QALY gained and remains less than €30,000/QALY in 94% of realizations produced by the Monte-Carlo simulation. Such a proportion increases to 97% when adopting a threshold of €40,000/QALY gained. Conclusions: Moving from the urgency criterion to evidence-based escalating strategies when prioritizing the access to new anti–hepatitis C virus treatments is a good investment in health, whose affordability should be explored through context-specific budget impact analyses.
2018
Inglese
Ruggeri, M., Coretti, S., Romano, F., Kondili, L. A., Vella, S., Cicchetti, A., Economic Evaluation of the Hepatitis C Virus Treatment Extension to Early-Stage Fibrosis Patients: Evidence from the PITER Real-World Cohort, <<VALUE IN HEALTH>>, 2018; 21 (7): 783-791. [doi:10.1016/j.jval.2017.10.021] [http://hdl.handle.net/10807/172952]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/172952
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