Cost effectiveness of Daclatasvir/Asunaprevir versus Peginterferon/Ribavirin and protease inhibitors for the treatment of Hepatitis C Genotype 1B in Chile

Abstract

A225 ombitasvir/dasabuvir) +/-ribavirin compared with Harvoni® (sofosbuvir/ledipasvir) in the United States. METHODS: A cost-effectiveness Markov model, based on previous HCV models, had 13 health states: 8 disease progression states (F0-F4, decompensated cirrhosis, hepatocellular carcinoma, and liver transplant), 3 sustained virologic response states, and 2 mortality states (liver-related and nonliver-related death). Transition rates were obtained from previous models. Adverse events, treatment-related disutility, and efficacy rates were based on phase 3 clinical trials. Baseline patient characteristics were derived from AbbVie 3D phase 3 clinical trials. Treatment durations were 24 weeks for GT1a experienced cirrhotic patients with AbbVie 3D and 8 weeks for 26% of GT1 treatment naïve patients with Harvoni. Direct medical costs were based on a systematic literature review and drug costs were based on December 2014 Red Book. The model was run over a lifetime horizon, discounting at 3% annually. Outcomes were measured in quality-adjusted life-years (QALYs). Probabilistic simulation analysis (PSA) was conducted by varying all parameters simultaneously. RESULTS: AbbVie 3D resulted in discounted lifetime costs per patient of $99,753 and 16.20 QALYs. Harvoni resulted in lifetime costs of $108,430 and 16.18 QALYs. With lower costs (-$8,677) and higher QALYs (0.02), AbbVie 3D dominated Harvoni. AbbVie 3D was superior in 98.4% of PSA simulations when QALYs were valued at $100,000 each. CONCLUSIONS: With higher QALYs and lower costs, AbbVie 3D dominated Harvoni in GT1-HCV-infected patients.OBJECTIVES: Evaluate the cost-effectiveness of universal rotavirus vaccination of children below age of five years old in the Philippine setting METHODS: We developed an age-stratified dynamic transmission model which compared four settings (baseline of no vaccine with 34% exclusive breastfeeding rate (EBR), two-dose monovalent vaccine (RV1), three-dose pentavalent vaccine (RV5), and no vaccine with 80% EBR) in the Philippine population over a 5-year time horizon. Model parameters such as cost and vital statistics were Philippine specific and other parameters such as vaccine efficacy and utility were extrapolated from literature. Univariate one-way and multivariate probabilities sensitivity analyses were conducted. RESULTS: Compared to baseline, the model showed that vaccination could lead to significant reduction in rotaviral morbidity and mortality in the 0 to < 5 age group as well as inducing herd immunity in the older groups. The incremental cost-effectiveness ratios (ICER) of vaccination versus baseline from a societal perspective were US$ 13,184/DALY for RV1 and US$ 11,836/ DALY for RV5; these are higher than the the current government cost-effectiveness threshold equal to the Philippine GNI per capita of US$ 3,134. Comparing 80% EBR to baseline, ICER is US$ 256,417/DALY. ICERs were sensitive to changes in case fatality, proportion of diarrhea cases due to rotavirus, and vaccine efficacy. The vaccine was cost-effective in less tha...

Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence

“…Evidence on the cost-effectiveness of expanded versus more restricted treatment is substantially more limited for low and middle-income countries. 73 Our review identified costeffectiveness analyses related to access to HCV treatment for Chile, 74 China, 6,7 Egypt, 37,38 India, 75 Iran, 76 South Africa, 19 and Thailand, 24 although these studies did not generally address our question of interest directly. The overall finding was that newer drugs offered substantial health benefits especially when broadly delivered but that sufficiently low drug prices were critical for costeffectiveness ( Table 7).…”

Modelling cost-effectiveness of syphilis detection strategies in prisoners: exploratory exercise in a Chilean male prison

“…Finally, to take into account the uncertainty associated with relevant parameters (see Table A2.2 in Additional file 1 : Appendix S2), a probabilistic analysis (1000 iterations) was performed. This analysis used ranges for the values according to the literature review, and statistical distribution based on a published cost-effectiveness analysis [ 25 ].…”

Modelling Cost-Effectiveness of Syphilis Detection Strategies in Prisoners: Exploratory Exercise in a Chilean Male Prison

“…Finally, to take into account for the uncertainty associated with relevant parameters (see Table A2.2 in Appendix 2), a probabilistic analysis (1000 iterations) was performed. This analysis uses ranges for the values according to the literature review, and statistical distribution based on a published cost-effectiveness analysis [25].…”