The University of Southampton
University of Southampton Institutional Repository

A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic hepatitis C virus

A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic hepatitis C virus
A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic hepatitis C virus
Background
Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs.

Objectives
To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients.

Methods
Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies.

Results
The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course.

Conclusions
Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective.
1098-3015
693-703
Fawsitt, Christopher G.
67259969-6139-4c91-9c46-13771aa1ea31
Vickerman, Peter
288014a9-9ed5-4207-adf5-64f63b0c6167
Cooke, Graham
a732b437-ff1f-4da0-a505-f7297adefdf4
Welton, Nicky J.
0af4518d-a999-469c-a46c-4a77fea140aa
Barnes, Eleanor
2ccdaa43-22ce-4cb1-91ca-2abb35df1966
Ball, Jonathan
ab4d36f4-4dc9-480e-b63d-462d3e834fd0
Brainard, Diana
e71e3940-ec86-4717-b8c6-da7132bc3a7c
Burgess, Gary
7803877f-2792-4593-be1d-4c66c3f45f94
Cooke, Graham
a732b437-ff1f-4da0-a505-f7297adefdf4
Dillon, John
70d10dfa-efcd-4a3d-bf74-85a143012df9
Foster, Graham
13beddb2-2185-42be-a578-30d907cc6a2a
Gore, Charles
75f81bd9-0212-4060-af0b-3bf9087bad25
Guha, Neil
a6f17c36-4601-4124-8abe-8d0999a18dca
Halford, Rachel
891edb04-6587-4564-9012-c9b69d39065d
Whitby, Kevin
7bd7a725-ca5f-4a03-8536-f5707becb2f3
Holmes, Chris
a4d53eee-2215-4c7c-a680-ec13202a629f
Howe, Anita
03aaf591-2f03-4557-91aa-81c01baeb1b2
Hudson, Emma
f3298804-a298-4fcf-9c00-ab554501a3a0
Hutchinson, Sharon
8e124af1-1224-4532-bcec-9f95b17fca36
Irving, William
ed6993df-07a9-4cc1-a859-aa616d644f43
Khakoo, Salim
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273
Klenerman, Paul
aa4c00a6-1a4d-4a4f-ac21-2131996344a7
Martin, Natasha
a897e4b7-c388-47a2-95fc-e7e6adaca6ee
Massetto, Benedetta
56ec7148-f668-4ac7-9ef8-69464f16ed14
Mbisa, Tamyo
2c22c2fe-e499-4a4d-9d5b-aaacf74193e1
Mchutchison, John
c533e145-da65-46f5-927a-54ee02073b73
Mckeating, Jane
b48bfbb5-8808-4adb-8f6e-d1c2876a63a0
Mclauchlan, John
bbd0b652-5cfb-40ea-afac-1ed7cd85a238
Miners, Alec
00f4a0ec-6a07-44c7-b1a4-f44c5b3fb400
Murray, Andrea
419706aa-b62b-412d-8db9-fa60311a89d2
Shaw, Peter
8e2c5a3d-5a27-4e18-9bf3-e8b277083f01
Simmonds, Peter
27d4c068-e352-4cbf-9899-771893788ade
Spencer, Chris
6bab753b-bcb7-41d8-a79b-8e3c904c6aef
Thomson, Emma
56756701-c8db-4b95-a453-910601c1f096
Vickerman, Peter
288014a9-9ed5-4207-adf5-64f63b0c6167
Zitzmann, Nicole
f20f9920-574a-4aac-a86f-1625dd60125c
Fawsitt, Christopher G.
67259969-6139-4c91-9c46-13771aa1ea31
Vickerman, Peter
288014a9-9ed5-4207-adf5-64f63b0c6167
Cooke, Graham
a732b437-ff1f-4da0-a505-f7297adefdf4
Welton, Nicky J.
0af4518d-a999-469c-a46c-4a77fea140aa
Barnes, Eleanor
2ccdaa43-22ce-4cb1-91ca-2abb35df1966
Ball, Jonathan
ab4d36f4-4dc9-480e-b63d-462d3e834fd0
Brainard, Diana
e71e3940-ec86-4717-b8c6-da7132bc3a7c
Burgess, Gary
7803877f-2792-4593-be1d-4c66c3f45f94
Cooke, Graham
a732b437-ff1f-4da0-a505-f7297adefdf4
Dillon, John
70d10dfa-efcd-4a3d-bf74-85a143012df9
Foster, Graham
13beddb2-2185-42be-a578-30d907cc6a2a
Gore, Charles
75f81bd9-0212-4060-af0b-3bf9087bad25
Guha, Neil
a6f17c36-4601-4124-8abe-8d0999a18dca
Halford, Rachel
891edb04-6587-4564-9012-c9b69d39065d
Whitby, Kevin
7bd7a725-ca5f-4a03-8536-f5707becb2f3
Holmes, Chris
a4d53eee-2215-4c7c-a680-ec13202a629f
Howe, Anita
03aaf591-2f03-4557-91aa-81c01baeb1b2
Hudson, Emma
f3298804-a298-4fcf-9c00-ab554501a3a0
Hutchinson, Sharon
8e124af1-1224-4532-bcec-9f95b17fca36
Irving, William
ed6993df-07a9-4cc1-a859-aa616d644f43
Khakoo, Salim
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273
Klenerman, Paul
aa4c00a6-1a4d-4a4f-ac21-2131996344a7
Martin, Natasha
a897e4b7-c388-47a2-95fc-e7e6adaca6ee
Massetto, Benedetta
56ec7148-f668-4ac7-9ef8-69464f16ed14
Mbisa, Tamyo
2c22c2fe-e499-4a4d-9d5b-aaacf74193e1
Mchutchison, John
c533e145-da65-46f5-927a-54ee02073b73
Mckeating, Jane
b48bfbb5-8808-4adb-8f6e-d1c2876a63a0
Mclauchlan, John
bbd0b652-5cfb-40ea-afac-1ed7cd85a238
Miners, Alec
00f4a0ec-6a07-44c7-b1a4-f44c5b3fb400
Murray, Andrea
419706aa-b62b-412d-8db9-fa60311a89d2
Shaw, Peter
8e2c5a3d-5a27-4e18-9bf3-e8b277083f01
Simmonds, Peter
27d4c068-e352-4cbf-9899-771893788ade
Spencer, Chris
6bab753b-bcb7-41d8-a79b-8e3c904c6aef
Thomson, Emma
56756701-c8db-4b95-a453-910601c1f096
Vickerman, Peter
288014a9-9ed5-4207-adf5-64f63b0c6167
Zitzmann, Nicole
f20f9920-574a-4aac-a86f-1625dd60125c

Fawsitt, Christopher G., Vickerman, Peter, Cooke, Graham, Welton, Nicky J., Barnes, Eleanor, Ball, Jonathan, Brainard, Diana, Burgess, Gary, Cooke, Graham, Dillon, John, Foster, Graham, Gore, Charles, Guha, Neil, Halford, Rachel, Whitby, Kevin, Holmes, Chris, Howe, Anita, Hudson, Emma, Hutchinson, Sharon, Irving, William, Khakoo, Salim, Klenerman, Paul, Martin, Natasha, Massetto, Benedetta, Mbisa, Tamyo, Mchutchison, John, Mckeating, Jane, Mclauchlan, John, Miners, Alec, Murray, Andrea, Shaw, Peter, Simmonds, Peter, Spencer, Chris, Thomson, Emma, Vickerman, Peter and Zitzmann, Nicole (2019) A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic hepatitis C virus. Value in Health, 22 (6), 693-703. (doi:10.1016/j.jval.2018.12.011).

Record type: Article

Abstract

Background
Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs.

Objectives
To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients.

Methods
Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies.

Results
The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course.

Conclusions
Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective.

Text
1-s2.0-S1098301519301019-main - Version of Record
Download (851kB)

More information

e-pub ahead of print date: 17 May 2019
Published date: 1 June 2019

Identifiers

Local EPrints ID: 435725
URI: http://eprints.soton.ac.uk/id/eprint/435725
ISSN: 1098-3015
PURE UUID: 043a5a71-3b05-462a-a37f-502168b32f32

Catalogue record

Date deposited: 19 Nov 2019 17:30
Last modified: 16 Dec 2019 17:30

Export record

Altmetrics

Contributors

Author: Christopher G. Fawsitt
Author: Peter Vickerman
Author: Graham Cooke
Author: Nicky J. Welton
Author: Eleanor Barnes
Author: Jonathan Ball
Author: Diana Brainard
Author: Gary Burgess
Author: Graham Cooke
Author: John Dillon
Author: Graham Foster
Author: Charles Gore
Author: Neil Guha
Author: Rachel Halford
Author: Kevin Whitby
Author: Chris Holmes
Author: Anita Howe
Author: Emma Hudson
Author: Sharon Hutchinson
Author: William Irving
Author: Salim Khakoo
Author: Paul Klenerman
Author: Natasha Martin
Author: Benedetta Massetto
Author: Tamyo Mbisa
Author: John Mchutchison
Author: Jane Mckeating
Author: John Mclauchlan
Author: Alec Miners
Author: Andrea Murray
Author: Peter Shaw
Author: Peter Simmonds
Author: Chris Spencer
Author: Emma Thomson
Author: Peter Vickerman
Author: Nicole Zitzmann

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×