Evaluating the cost-effectiveness of using boceprevir and telaprevir in the treatment of newly diagnosed Hepatitis C Genotype 1 patients: A payer's perspective

Purpose: The addition of protease inhibitors, boceprevir or telaprevir, to pegylated interferon alpha and ribavirin (usual care) results in  an improved sustained virologic response (SVR) in newly diagnosed Genotype 1 Chronic Hepatitis C (HCV) patients. The objective of this study was to evaluate the cost-effectiveness of all currently recommended pharmacotherapies from a payer’s  perspective in this population. 

Methods: A Markov model was developed to simulate treatment effectiveness, costs and disease progression in a hypothetical cohort of newly diagnosed HCV patients . In addition to the usual care, triple therapies with usual care and boceprevir or telaprevir were considered.  The model included the following outcomes: SVR, eventual disease progression to long-term adverse outcomes in those who did not achieve SVR or relapsed, and side effects. Probabilities, costs and utility values were determined from a review of the published literature. All costs were inflated to 2012 costs. Costs and quality adjusted life years were also discounted at standard rate of 5%. Sensitivity analyses were performed to assess model sensitivity and address uncertainty.  

Results:

Boceprevir therapy resulted in lifetime costs and utilities of $106,376 and 12.68 QALYs compared to $92,440 and 12.66 QALYs for Telaprevir therapy and $83,036 and 12.19 QALYs for usual care. The ICER was found to be $47,173/QALY for boceprevir and $19,878/QALY for telaprevir relative to usual care. The ICER was found to be $642,485/QALY for boceprevir relative to telaprevir. The model was found to be most sensitive to variations in costs of initial drug therapy.   

Conclusion: Results indicate that when possible, telaprevir should be the preferred therapy for the Genotype 1 HCV patients. In patients where telaprevir is not tolerated or cannot be given, boceprevir should be the next preferred therapy. Effective management of side-effects is important to reduce the impact on rate of achieving sustained virological response.