Cost-effectiveness analysis is a mandatory strategy for health systems: evidence from a study involving therapies for hepatitis C.

João Paulo Vilela Rodrigues,Maurílio De Souza Cazarim,Ana De Lourdes Candolo Martinelli,Silvana Gama Florencio Chachá,Leonardo Régis Leira Pereira

doi:10.1590/0102-311x00036619

Abstract

Cost-effectiveness analysis is essential in health decision making. Several countries use it as synthesis of evidence to incorporate health technologies. The protease inhibitors (PI) boceprevir (BOC) and telaprevir (TVR) are indicated for chronic hepatitis C treatment and were incorporated in guidelines worldwide. Pre-marketing clinical trials showed higher sustained virological response rates in relation to previous therapies, but the incorporation of PIs generated a significant financial impact. The aim of this study was to discuss the relevance of cost-effectiveness analysis through a study that involved the inclusion of PIs in a clinical protocol. The analysis was part of a real-life study that included patients infected with hepatitis C virus genotype 1 treated in a tertiary university hospital in Brazil. Triple therapies (TT) with ribavirin (RBV), peginterferon α-2a (Peg-INF α-2a) and BOC or TVR were compared to dual therapy with RBV and Peg-INF α-2a. Sensitivity analysis of the cost-effectiveness ratio indicated an 88.2% chance of TTs presenting a higher cost per cure. The incremental cost-effectiveness ratios (ICER) exceeded the Brazilian gross domestic product (GDP) per capita by three times in all proposed scenarios. The sensitivity of ICER showed an 88.4% chance of TT not being cost-effective. The impact of PI incorporation was negative and the conduct about this could have been different if a previous cost-effectiveness analysis had been conducted.

Highlights

The viability of health systems – especially public ones with universal coverage – is related to the rational use of financial resources
Even providing a perfect scenario for the response of Triple therapies (TT) compared to dual therapy (DT), when TT have the best Net monetary benefits (NMB) chance and DT the worst, the result was that TT should be 70% better than DT for the effectiveness of TT to be better than DT
Sensitivity analyses showed that TT are more likely to have a higher cost per cure (CER) and extra cure (ICER) than DT, reaching more than 80% of the probabilities

Summary

Introduction

The viability of health systems – especially public ones with universal coverage – is related to the rational use of financial resources. Such resources are usually scarce to meet the demand of a population that presents an increasing life expectancy and is affected by chronic diseases that require continuous health care. Cost-effectiveness analysis is established as a necessary instrument for decision making processes. This analysis compares therapeutic options indicated for the same clinical condition considering costs and effectiveness, allowing maximum health benefits or that a greater number of patients are followed-up and benefited from the available resources 1. Estimations state that up to 20% of CHC patients develop cirrhosis over 20-30 years of infection 3

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