Abstract
BackgroundNew interferon (IFN)-free treatments for hepatitis C are more effective, safer but more expensive than current IFN-based therapies. Comparative data of these, versus current first generation protease inhibitors (PI) with regard to costs and treatment outcomes are needed. We investigated the real-world effectiveness, safety and cost per cure of 1st generation PI-based therapies in the UK.MethodsMedical records review of patients within the HCV Research UK database. Patients had received treatment with telaprevir or boceprevir and pegylated interferon and ribavirin (PR). Data on treatment outcome, healthcare utilisation and adverse events (AEs) requiring intervention were collected and analysed overall and by subgroups. Costs of visits, tests, therapies, adverse events and hospitalisations were estimated at the patient level. Total cost per cure was calculated as total median cost divided by SVR rate.Results154 patients from 35 centres were analysed. Overall median total cost per cure was £44,852 (subgroup range,: £35,492 to £107,288). Total treatment costs were accounted for by PI: 68.3 %, PR: 26.3 %, AE management: 5.4 %. Overall SVR was 62.3 % (range 25 % to 86.2 %). 36 % of patients experienced treatment-related AEs requiring intervention, 10 % required treatment-related hospitalisation.ConclusionsThis is the first UK multicentre study of outcomes and costs of PI-based HCV treatments in clinical practice. There was substantial variation in total cost per cure among patient subgroups and high rates of treatment-related discontinuations, AEs and hospitalisations. Real world safety, effectiveness and total cost per cure for the new IFN free combinations should be compared against this baseline.Electronic supplementary materialThe online version of this article (doi:10.1186/s41124-016-0002-z) contains supplementary material, which is available to authorized users.
Highlights
New interferon (IFN)-free treatments for hepatitis C are more effective, safer but more expensive than current IFN-based therapies
Evidence suggests that treatment-related adverse event (AE) have a negative impact on health-related quality of life (HRQoL) leading to higher rates of premature discontinuation and lower SVR rates than reported from clinical trials [9, 10]
Evidence from clinical trials suggests that in treatment naïve genotype 1 patients, triple therapy of pegylated interferon and ribavirin (PR) + 1st generation protease inhibitors (PI) results in SVR rates of between 65–75 % [11,12,13,14] lower effectiveness has been reported in real-world studies (44–55 %) [15,16,17,18]
Summary
New interferon (IFN)-free treatments for hepatitis C are more effective, safer but more expensive than current IFN-based therapies. IFN based HCV treatment is able to cure HCV (as defined by sustained virological response, SVR) [2] which is associated with improved clinical outcomes [4,5,6]. Evidence suggests that treatment-related AEs have a negative impact on health-related quality of life (HRQoL) leading to higher rates of premature discontinuation and lower SVR rates than reported from clinical trials [9, 10]. Evidence from clinical trials suggests that in treatment naïve genotype 1 patients, triple therapy of PR + 1st generation PIs results in SVR rates of between 65–75 % [11,12,13,14] lower effectiveness has been reported in real-world studies (44–55 %) [15,16,17,18]
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