Vincenza Capursi

Cost-effectiveness of boceprevir or telaprevir for previously treated patients with genotype 1 chronic hepatitis C

BACKGROUND & AIMS Randomised controlled trials (RCTs) show that triple therapy (TT) with peginterferon alfa, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of genotype 1 (G1) chronic hepatitis C (CHC) patients with previous relapse (RR), partial response (PAR), and null-response (NR). We assess the cost-effectiveness of TT compared to no therapy in the treatment of patients previously treated with G1 CHC. METHODS The available published literature provided the data source. The target population was made up of previously treated Caucasian patients with G1 CHC and these were evaluated over a lifetime horizon by Markov model. The study was carried out from the perspective of the Italian National Health Service. Outcomes included discounted costs (in euro at 2012 value), life years gained (LYG), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER).The robustness of the results was evaluated by one-way deterministic and multivariable probabilistic sensitivity analyses. RESULTS In RR patients, ICER per LYG compared to no therapy was €9555 for BOC-LEAD-IN-RR and €7910 for TVR-LEAD-IN-RR, being BOC dominated by TVR. In PAR patients, ICER for LYG was €11,947 for BOC-LEAD-IN-PAR and €14,931 for TVR-PAR, being TVR cost-effective compared to BOC (ICER for QALY €22,258). In NR patients, ICER for LYG was €26,499 for TVR-LEAD-IN-NR. The models were sensitive to likelihood of sustained virological response and to BOC/TVR prices. CONCLUSIONS 1st generation HCV PI is highly cost-effective compared to no therapy in RR and PAR G1 CHC patients. TVR dominated BOC in RR, and was cost-effective compared to BOC in PAR patients. In NR patients an assessment of the response after a lead-in period should be performed to improve safety and cost-effectiveness.

Cost-effectiveness of boceprevir or telaprevir for untreated patients with genotype 1 chronic hepatitis C

Randomized controlled trials (RCTs) show that triple therapy (TT) with peginterferon alpha, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon‐ribavirin dual therapy (DT) in the treatment of previously untreated patients with genotype 1 (G1) chronic hepatitis C (CHC). We assessed the cost‐effectiveness of TT compared to DT in the treatment of untreated patients with G1 CHC. We created a Markov Decision Model to evaluate, in untreated Caucasian patients age 50 years, weight 70 kg, with G1 CHC and Metavir F2 liver fibrosis score, for a time horizon of 20 years, the cost‐effectiveness of the following five competing strategies: 1) boceprevir response‐guided therapy (BOC‐RGT); 2) boceprevir IL28B genotype‐guided strategy (BOC‐IL28B); 3) boceprevir rapid virologic response (RVR)‐guided strategy (BOC‐RVR); 4) telaprevir response‐guided therapy (TVR‐RGT); 5) telaprevir IL28B genotype‐guided strategy (TVR‐IL28B). Outcomes included life‐years gained (LYG), costs (in 2011 euros) and incremental cost‐effectiveness ratio (ICER). In the base‐case analysis BOC‐RVR and TVR‐IL28B strategies were the most effective and cost‐effective of evaluated strategies. LYG was 4.04 with BOC‐RVR and 4.42 with TVR‐IL28B. ICER compared with DT was €8.304 per LYG for BOC‐RVR and €11.455 per LYG for TVR‐IL28B. The model was highly sensitive to IL28B CC genotype, likelihood of RVR and sustained virologic response, and BOC/TVR prices. Conclusion: In untreated G1 CHC patients age 50 years, TT with first‐generation protease inhibitors is cost‐effective compared with DT. Multiple strategies to reduce costs and improve effectiveness include RVR or genotype‐guided treatment. (HEPATOLOGY 2012;56:850–860)

Statistical methods for the evaluation of university systems

Part I - Introduction: Different Perspectives of the Evaluation of the Italian University System.- Part II - The Evaluation in the Italian Universities. Student Teaching Evaluation.- Part III - The Evaluation in the Italian Universities. Statistical Methods for Careers and Services Evaluation.- Part IV - Research Design and data for Evaluation: University between the High School and the Labour Market.

Statistics in Education

During the last few decades, educational systems have attracted a great deal of interest because they are closely related to economic and social systems. For example, ‘higher education has been aff...

Building up adjusted indicators of students' evaluation of university courses using generalized item response models

This article advances a proposal for building up adjusted composite indicators of the quality of university courses from students’ assessments. The flexible framework of Generalized Item Response Models is adopted here for controlling the sources of heterogeneity in the data structure that make evaluations across courses not directly comparable. Specifically, it allows us to: jointly model students’ ratings to the set of items which define the quality of university courses; explicitly consider the dimensionality of the items composing the evaluation form; evaluate and remove the effect of potential confounding factors which may affect students’ evaluation; model the intra-cluster variability at course level. The approach simultaneously deals with: (i) multilevel data structure; (ii) multidimensional latent trait; (iii) personal explanatory latent regression models. The paper pays attention to the potential of such a flexible approach in the analysis of students evaluation of university courses in order to explore both how the quality of the different aspects (teaching, management, etc.) is perceived by students and how to make meaningful comparisons across them on the basis of adjusted indicators.

Can the Students’ Career be Helpful in Predicting an Increase in Universities Income?

The students’ academic failure and the delay in obtaining their final degree are a significant issue for the Italian universities and their stakeholders. Based on indicators proposed by the Italian Ministry of University, the Italian universities are awarded a financial incentive if they reduce the students’ attrition and failure. In this paper we analyze the students’ careers performance using: (1) aggregate data; (2) individual data. The first compares the performances of the Italian universities using the measures and the indicators proposed by the Ministry. The second analyzes the students’ careers through an indicator based on credit earned by each student in seven academic years. The primary goal of this paper is to highlight elements that can be used by the policy makers to improve the careers of the university students.