James Pitcavage

Cost-Effectiveness of IL28Β Genotype-Guided Protease Inhibitor Triple Therapy versus Standard of Care Treatment in Patients with Hepatitis C Genotypes 2 or 3 Infection

Background/Aims: Triple therapy [adding protease inhibitors to standard of care (SOC)] dramatically increases treatment response in selected patients with hepatitis C virus (HCV). Interleukin 28B (IL28Β) genotyping helps predict responsiveness in these patients; however, the economic implications of IL28Β genotyping in HCV genotype 2 or 3 infected patients are unknown. Short- and long-term costs and outcomes of SOC therapy were calculated and used to determine the cost-effectiveness thresholds for using triple therapy in HCV genotype 2 or 3 infected patients. Methods: Costs and outcomes were calculated by conducting cohort simulations on decision trees modeling SOC and triple therapy. Quality-adjusted life expectancies and long-term costs were predicted through Markov modeling. Results: For triple therapy to be cost-effective, sustained virologic response (SVR) rates must improve (depending on age) by 7.91-11.11 and 9.06-12.8% for HCV genotype 2 and 3 cohorts, respectively. When triple therapy is guided by 2 IL28Β variants, a 2.63-3.72% improvement in SVR is needed for cost-effectiveness, and when guided by only one variant, a 1.4-8.91% improvement is needed. Conclusions: Markov modeling revealed that modest increases in SVR rates from IL28Β-guided triple therapy can lead to both lower costs and better health outcomes than SOC therapy in the long run.

Contents Vol. 17, 2014

R. Adany, Debrecen, Hungary A. Aaro, Odense, Denmark D. Avard, Montréal, Qué., Canada I. Blancquaert, Montréal, Qué., Canada J.-J. Cassiman, Leuven, Belgium E.E. Castilla, Rio de Janeiro, Brazil S. Grosse, Atlanta, Ga., USA J. Harris, Oslo, Norway A. Haslberger, Vienna, Austria D. Ibarreta, Sevilla, Spain M. Karmali, Toronto, Ont., Canada H. Lehrach, Berlin, Germany J. Little, Ottawa, Ont., Canada N. Malats, Madrid, Spain C. McBride, Bethesda, Md., USA S.A. Morré, Amsterdam, Th e Netherlands P. O’Leary, Perth, W.A., Australia F. Paccaud, Epalinges, Switzerland B. Peterlin, Ljubljana, Slovenia Editor-in-Chief

A1-2: Cost-Effectiveness of Interleukin 28B Genotype-Guided Protease Inhibitor Therapy in Treatment-Naïve Patients with Hepatitis C Virus Genotype 2 or 3

Background/Aims The addition of protease inhibitors to standard of care (SOC) dramatically increases treatment response in Hepatitis C Virus (HCV) genotype 1 patients. Moreover, Interleukin 28B (IL28B) genotyping helps predict responsiveness for these patients. However, the economic implications of incorporating IL28B genotyping in HCV genotype 2 or 3 infected patients are unknown. This study used a treatment algorithm that included IL28B genotype-guided therapy to examine the short and long-term cost-effectiveness of utilizing these single-nucleotide polymorphisms in treatment-naïve HCV genotype 2 or 3 infected patients. Methods A treatment algorithm was constructed to reflect a therapy regimen for treatment-naïve patients with HCV genotype 2 or 3 infection using pegylated-interferon, ribavirin, and telaprevir. To examine the role of the IL28B gene in affecting costs and health outcomes, a decision tree was derived from the treatment algorithm in order to populate a predictive cost model for therapy using our treatment algorithm. Results Expected short-term costs of therapy following our algorithm were

Alternative consent models for comparative effectiveness studies: Views of patients from two institutions

21,648.92 and

Burden of Readmissions Among Patients With Critical Limb Ischemia

47,972.84 for the CC and TT genotypes at rs12979860, respectively, and

The impact of free trial acceptance on demand for alternative nicotine products: evidence from experimental auctions

47,972.84 and

A Cost-Effectiveness Analysis of A Test That Predicts Risk of Malignant Progression In Barrett’s Esophagus

21,648.92 for patients with the CT genotype at rs12979860 and the TG/GG and TT genotypes at rs8099917, respectively. Predicted costs among patients undergoing SOC therapy were

Value of Physician Performance in Diabetes System of Care Among Elderly Medicare Patients: Implications for Pay-for-Performance

20,758.92. Sustained virologic response (SVR) rates for genotypes 2/3 were predicted to occur in 82.2% (8,220 of 10,000) of patients overall—88.83% (8,883 of 10,000) and 65.91% (6,591 of 10,000) for the CC and TT genotypes at rs12979860 and 81.01% (8,101 of 10,000) overall for patients with the CT genotype at rs12979860 [72.08% (7,208 of 10,000) and 86.78% (8,678 of 10,000) for the TG/GG and TT genotypes at rs8099917]. Markov modeling predicted a 27.29 quality-adjusted life-expectancy (QALE) after following our treatment algorithm while adding

Analysis of an Integrated Diabetes Care Program and Impact on Health Outcomes and Utilization

7,766.51 in long-term costs. The model predicted only a 26.65 QALE after SOC therapy (while adding

High-Risk Breast Cancer Clinic –– A New Risk-Stratified, Evidence-Based, and Efficient Patient Care Model

9,599.05 in long-term costs). Conclusions Although short-term treatment costs of an IL28B genotype-guided approach exceed those of SOC for treatment-naïve HCV genotype 2/3 infected patients, Markov modeling suggests that lower long-term costs and improved health outcomes may be achieved by the proposed algorithm and provides a dominant cost-effective strategy for treating this population of HCV infected patients.