Outcomes and Costs of Treating Hepatitis C Patients in the Era of First Generation Protease Inhibitors – Results from the PAN Study

Abstract

1. ObjectiveChronic hepatitis C virus infections (HCV) cause a significant public health burden. Introduction of telaprevir (TVR) and boceprevir (BOC) has increased sustained virologic response rates (SVR) in genotype 1 patients but were accompanied by higher treatment costs and more side effects. Aim of the study was to assess outcomes and costs of treating HCV with TVR or BOC in routine care.2. Material and MethodsData was obtained from a non-interventional study. This analysis relates on a subset of 1,786 patients for whom resource utilisation was documented. Sociodemografic and clinical parameters as well as resource utilisation were collected using a web-based data recording system. Costs were calculated using official remuneration schemes.3. ResultsMean age of patients was 49.2 years, 58.6% were male. In treatment-naive patients SVR-rates of 62.2% and 55.7% for TVR and BOC were observed (prior relapser: 68.5% for TVR and 63.5% for BOC; prior non-responder: 45.6% for TVR and 39.1% for BOC). Treatment costs are dominated by costs for pharmaceuticals and range between €39,081 and €53,491. We calculated average costs per SVR of €81,347 (TVR) and €70,163 (BOC) in treatment-naive patients (prior relapser: 78,089 €/SVR for TVR and 82,077 €/SVR for BOC; prior non-responder: 116,509 €/SVR for TVR and 110,156 €/SVR for BOC). Quality of life data showed a considerable decrease during treatment.4. ConclusionOur study is one of few investigating both, outcomes and costs, of treating HCV in a real-life setting. Data can serve as a reference in the discussion of increasing costs in recently introduced agents.

Cost per care of the first year of direct antiviral agents in the Liguria Region: a multicenter analysis

“…In our cohort, 77.3% of patients had a METAVIR score F4 defined by fibroscan or liver biopsy. 37 Therefore, the more advanced the liver fibrosis, the higher the risk of anemia, as already shown by other studies. 38 However, given the current trend in reducing the use of RBV, 39 the impact of this element will be further reduced.…”

“…The PAN study, a large German study based on first-generation DAAs, reported the same side effect only in 2.4%,37 but in that study, only 17.3% of the cohort presented an advanced fibrosis or liver cirrhosis (determined by AST to platelet ratio index). In our cohort, 77.3% of patients had a METAVIR score F4 defined by fibroscan or liver biopsy 37. Therefore, the more advanced the liver fibrosis, the higher the risk of anemia, as already shown by other studies 38.…”

“…Anemia requiring support with high-cost drugs was observed in 42 patients (12.4%). The PAN study, a large German study based on first-generation DAAs, reported the same side effect only in 2.4%, 37 but in that study, only 17.3% of the cohort presented an advanced fibrosis or liver cirrhosis (determined by AST to platelet ratio index). In our cohort, 77.3% of patients had a METAVIR score F4 defined by fibroscan or liver biopsy.…”

Non-Invasive Reliable Methods to Objectify the Positive Influence of Hepatitis C Virus Treatment on Liver Stiffness

“…Current German guidelines recommend interferon-free regimens as first-choice treatment [ 37 ]. Further, evidence is accumulating that DAA therapies provide a cost-effective means to reduce the morbidity and mortality associated with chronic infection with HCV [ 20 ]. In our study, all patients achieved SVR of 100% 6 months after therapy.…”

“…HCV infection leads to liver fibrosis (LF) up to LC and/or hepatocellular carcinoma (HCC) and reduced life expectancy [ 9 , 14 - 18 ]. Successful treatment of HCV infection stops LF progression and partially reverses it [ 19 , 20 ].…”