Abstract
Objectives: direct-acting antivirals containing nonstructural protein 5A (NS5A) inhibitors administered over 8 to 12 weeks are effective in ∼95% of patients with hepatitis C virus. Nevertheless, patients resistant to NS5A inhibitors have lower cure rates over 8 weeks (<85%); for these patients, 12 weeks of treatment produces cure rates greater than 95%. We evaluated the lifetime cost-effectiveness of testing for NS5A resistance at baseline and optimizing treatment duration accordingly in genotype 1 noncirrhotic treatment-naïve patients from the perspective of the UK National Health Service.
Methods: a decision-analytic model compared (1) standard 12-week treatment (no testing), (2) shortened 8-week treatment (no testing), and (3) baseline testing with 12-/8-week treatment for those with/without NS5A polymorphisms. Patients who failed first-line therapy were retreated for 12 weeks. Model inputs were derived from published studies. Costs, quality-adjusted life-years, and the probability of cost-effectiveness were calculated.
Results: baseline testing had an incremental net monetary benefit (INMB) of £11 838 versus standard 12 weeks of therapy (no testing) and low probability (31%) of being the most cost-effective, assuming £30 000 willingness to pay. Shortened 8 weeks of treatment (no testing) had an INMB of £12 294 and the highest probability (69%) of being most cost-effective. Scenario analyses showed baseline testing generally had the highest INMB and probability of being most cost-effective if first- and second-line drug prices were low (<£20k).
Conclusions: optimizing treatment duration based on NS5A polymorphisms for genotype 1 noncirrhotic treatment-naive patients in the United Kingdom is not cost-effective if the drug costs are high; the strategy is generally most cost-effective when drug prices are low (<£20k).
More information
e-pub ahead of print date: 24 October 2019
Published date: 26 February 2020
Additional Information:
Funding Information: this work was supported by the Medical Research Council (in the United Kingdom) STOP-HCV-1 project ( MR/K01532X/1 ). N.J.W. and P.V. were supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England (PHE). G.S.C. is supported in part by the BRC of Imperial College NHS Trust and NIHR Research Professorship. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, the Department of Health, or Public Health England. We thank the reviewers of the article for their very helpful and valuable comments. Finally, we thank the STOP HCV Consortium for their input to this work: Prof Eleanor Barnes, 1 Prof Jonathan Ball, 2 Dr Diana Brainard, 3 Dr Gary Burgess, 4 Dr Graham S. Cooke, 5 Prof John Dillon, 6 Prof Graham Foster, 7 Mr Charles Gore, 8 Dr Neil Guha, 2 Ms Rachel Halford, 8 Dr Kevin Whitby, 9 Prof Chris Holmes, 10 Dr Anita Howe, 11 Dr Emma Hudson, 1 Prof Sharon Hutchinson, 12 Prof William Irving, 2 Prof Salim Khakoo, 13 Prof Paul Klenerman, 1 Dr Natasha Martin, 14 Dr Benedetta Massetto, 3 Dr Tamyo Mbisa, 15 Dr John McHutchison, 3 Prof Jane McKeating, 1 Dr John McLauchlan, 16 Dr Alec Miners, 17 Dr Andrea Murray, 18 Dr Peter Shaw, 19 Prof Peter Simmonds, 1 Dr Chris Spencer, 20 Dr Emma Thomson, 16 Prof Peter Vickerman, 21 and Prof Nicole Zitzmann. 22 1 Nuffield Department of Medicine and the Oxford NHIR BRC, University of Oxford, Oxford, England, UK 2 University of Nottingham, Queen’s Medical Centre, Nottingham, England, UK 3 Gilead Sciences, Inc, Foster City, CA, USA 4 Conatus Pharmaceuticals, San Diego, CA, USA 5 Wright-Fleming Institute, Imperial College, London, England, UK 6 University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, UK 7 Queen Mary University of London, London, England, UK 8 Hepatitis C Trust, London, England, UK 9 Gilead Sciences, Middlesex, England, UK 10 Nuffield Department of Medicine and Department of Statistics, University of Oxford, Oxford, England, UK 11 BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada 12 Glasgow Caledonian University, Glasgow, Scotland, UK 13 University of Southampton, Southampton, England, UK 14 UC San Diego, La Jolla, CA, USA 15 Public Health England, London, England, UK 16 Centre for Virus Research, Glasgow, Scotland, UK 17 London School of Hygiene & Tropical Medicine, London, England, UK 18 OncImmune Limited, Nottingham, England, UK 19 Merck & Co, Inc, Kenilworth, NJ, USA 20 Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, England, UK 21 University of Bristol, Clifton, England, UK 22 University of Oxford, South Parks Road, Oxford, England, UK
Keywords:
baseline testing, cost-effectiveness, hepatitis C virus, resistance-associated polymorphisms
Identifiers
Local EPrints ID: 484930
URI: http://eprints.soton.ac.uk/id/eprint/484930
ISSN: 1098-3015
PURE UUID: 995cf123-2773-4b56-a0a5-3561f8902ad8
Catalogue record
Date deposited: 24 Nov 2023 17:40
Last modified: 18 Mar 2024 02:55
Export record
Altmetrics
