A study, led by Boston Medical Center (BMC) researchers, assessed the cost-effectiveness of expensive new hepatitis C drugs and found that while they are highly effective, they are cost-effective and provide the greatest value in a specific groups of patients with hepatitis C.
Findings from the study, led by Benjamin P. Linas, MPH, from the BMC’s section of Infectious diseases and the Boston University School of Medicine (BUSM), were published in the Annals of Internal Medicine.
The study focused on the combination of Gilead Sciences’ Sovaldi (sofosbuvir) and ribavirin for the treatment of hepatitis C virus (HCV) genotypes 2 and 3, which account for about 25 percent of all HCV cases in the US. These drugs were the first all-oral combination therapy approved for HCV treatment. Although the medication regimen has demonstrated its effectiveness, curing more than 90 percent of patients, the wholesale cost of Sovaldi is approximately $85,000 per treatment course, putting a strain on insurance budgets and leading to treatment restrictions.
Linas and his team used a simulation model to project outcomes, costs and cost-effectiveness of sofosbuvir-based treatments for HCV genotype 2 or 3 infection in the US and found that at these costs, sofosbuvir-based HCV therapy provides excellent economic value in genotype 2 or 3 infected patients who already have advanced liver disease. Additionally, they found that it is also cost-effective for patients who have failed treatment with other drugs.
However, in patients without cirrhosis who have never been treated and for whom the less expensive pegylated interferon-ribavirin remains an option, sofosbuvir-based therapy is not considered cost-effective. In those cases, the sofosbuvir-based therapy for genotype 2 or 3 infection cost well over $100,000 for each quality-adjusted life year gained that insurers use.
The authors noted that the potential benefits of interferon-free treatments are lower if the interferon-based treatment is an option and works with 80 percent efficacy in treatment-naïve patients. The authors also said that patients are at low risk of death from HCV until developing cirrhosis, and not all patients will. As a result, the sustained virologic response benefits of interferon-free therapy do not directly translate into large boosts in life expectancy or quality-adjusted life expectancy in patients without cirrhosis.
“These new oral treatments provide better clinical results with fewer side effects for all patients, but at the current price, are only good value for those who need treatment the most – patients with advanced liver disease or those who failed prior therapy,” said Linas. “With lower costs, it would be reasonable to provide these better regimens to all patients.”
Source: Boston Medical Center
Last updated: 3/31/15; 3:40pm EST