S. van Sanden

The cost of treatment failure: resource use and costs incurred by hepatitis C virus genotype 1–infected patients who do or do not achieve sustained virological response to therapy

Chronic hepatitis C virus (HCV) infection places a considerable economic burden on health services. Cost‐effectiveness analyses of antiviral treatment for patients with chronic HCV infection are dependent on assumptions about cost reductions following sustained virological response (SVR) to therapy. This study quantified the medium‐term difference in health resource usage and costs depending on treatment outcome. Retrospective chart review of patients with HCV genotype 1 infection who had received at least 2 months pegylated interferon and ribavirin therapy, with known treatment outcome was conducted. Disease status was categorized as chronic hepatitis, cirrhosis or decompensated liver disease. Health resource use was documented for each patient in each disease state. Unit costs were from the NHS ‘Payment by Results’ database and the British National Formulary. One hundred and ninety three patients (108 SVR, 85 non‐SVR) with mean follow‐up of 3.5 (SVR) and 4.9 (non‐SVR) years were enrolled. No SVR patient progressed to a more severe liver disease state. Annual transition rates for non‐SVR patients were 7.4% (chronic hepatitis to cirrhosis) and 4.9% (cirrhosis to decompensated liver disease). By extrapolation of modelled data over a 5‐year post‐treatment period, failure of patients with chronic hepatitis to achieve SVR was associated with a 13‐fold increase (roughly £2300) in costs, whilst for patients who were retreated, the increase was 56‐fold, equating to more than £10 000. Achievement of an SVR has significant effects on health service usage and costs. This work provides real‐life data for future cost‐effectiveness analyses related to the treatment for chronic HCV infection.

Mixed Treatment Comparisons to Compare Simeprevir with Boceprevir and Telaprevir in Combination with Peg-Interferon Alpha and Ribavirin (Pr) in Patients Infected with Genotype 1 Hepatitis C Virus (Hcv)

The main aim of this systematic review was to analyse and compare the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of C. difficile infection. Methods: Systematic review and meta-analysis of the literature using Bayesian mixed treatment comparison. Results: Nine studies were included in the mixed-treatment comparison. Our meta-analysis showed that clinical cure was more likely with fidaxomicin compared to vancomycin and metronidazole, however the differences were not significant. (odds ratios [95% CI]: fidaxomicin vs. vancomycin 1.19 [0.82-1.66]; vancomycin vs. metronidazole 1.69 [0.93-2.82] and fidaxomicin vs. metronidazole 2.00 [0.99-3.66]). Fidaxomicin therapy was significantly more efficacious than vancomycin and metronidazole in endpoints of recurrence (odds ratios [95% CI]: fidaxomicin vs. vancomycin 0.47 [0.33-0.65]; vancomycin vs. metronidazole 0.91 [0.44-1.69] and fidaxomicin vs. metronidazole 0.43 [0.19-0.85]) and sustained cure (odds ratios [95% CI]: fidaxomicin vs. vancomycin 1.77 [1.352.28]; vancomycin vs. metronidazole 1.49 [0.92-2.30]; and fidaxomicin vs. metronidazole 2.64 [1.50-4.35]. There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints. ConClusions: Fidaxomicin was the most efficacious therapeutic alternative in lowering the rate of recurrent C. difficile infections.