PIN75 - Cost-Effectiveness of Telaprevir Plus Peginterferon/Ribavirin (TVR+PR) Versus Peginterferon/Ribavirin (PR) in Treatment-Naïve Genotype 1 Chronic Hepatitis C Patients with F2 Fibrosis in Brazil

Abstract

To compare the cost-effectiveness of telaprevir associated with peginterferon and ribavirin (TVR+PR) compared to peginterferon and ribavirin (PR) alone in the treatment of patients with METAVIR scale F2) fibrosis and with previously untreated chronic hepatitis C genotype 1. Markov model, Curtis et al 2012, was adapted to a Brazilian public payer perspective. The model estimated chronic hepatitis C disease progression based on transition probabilities for a cohort of patients with F2 fibrosis. Clinical outcomes and drug dosage were taken from the phase-3 trial (Marcellin et al), with the SVR-rate for TVR+PR as 79% and 49% for PR in patients with F2 fibrosis. Drug costs of TVR and PR were gathered from the ministry of health website, www.comprasnet.gov.br. Costs associated with each disease state were gathered from a study by Barros et al. A discount rate of 3.5 % and a lifetime horizon were assumed. TVR+PR therapy resulted in higher costs (R$ BRL57,164 vs BRL27,971) and better outcomes (278 cirrhosis avoided per 1,000 patients) compared to PR alone. Treatment with TVR+PR resulted in 19.94 life years gained compared to PR alone with 19.19. TVR+PR was estimated to give a quality adjusted life year (QALY) expectancy of 13.83, 1.16 higher than with PR (12.67 QALYs), resulted in an incremental cost-effectiveness ratio (ICER) of R$23,734 per QALY gained. Compared to PR alone, the treatment with TVR+PR avoided about 11 deaths and 17 liver transplants per 1,000 treated patients. Treatment with TVR+PR resulted in an incremental cost of R$1,595 per liver transplant avoided and R$2,613 per death avoided compared to PR alone. Treating F2 fibrosis patients with TVR+PR was cost-effective compared with PR alone with an ICER below to the WHO recommended threshold. The benefits of TVR+PR treatment were clear with the low incremental cost per death or liver transplant avoided.