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

Abstract

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.

Meta-Analysis: Superior Treatment Response in Asian Patients with Hepatitis C Virus Genotype 6 versus Genotype 1 with Pegylated Interferon and Ribavirin

“…Additionally, the economic burden of not achieving SVR and/or retreatment is much higher in patients that do not achieve SVR versus those that achieve SVR [61]. In a study by Backx et al , the authors demonstrated that failure to achieve SVR was associated with a 13-fold increase in healthcare-related costs, which was related to a higher likelihood of a patient transitioning to a more severe disease state that required more healthcare, while the costs were 56-fold higher for retreated patients [61].…”

“…In a study by Backx et al , the authors demonstrated that failure to achieve SVR was associated with a 13-fold increase in healthcare-related costs, which was related to a higher likelihood of a patient transitioning to a more severe disease state that required more healthcare, while the costs were 56-fold higher for retreated patients [61]. Given that PEG-IFN+RBV is associated with significant side effects and requires a full year of treatment, the risk, benefits, and cost-savings of treatment should be discussed with the patient and the decision to continue treatment if a patient does not achieve EVR should be individualized.…”

Cost-effectiveness of Early Treatment of Hepatitis C Virus Genotype 1 by Stage of Liver Fibrosis in a US Treatment-Naive Population

“…42–44 Pre-SVR costs ($810 for stages F0-F2, $2150 for stage F3, and $2575 for stage F4) were based on costs from a managed care database that were adjusted for the proportion of known chronic HCV cases estimated to receive health care. 44,45 Post-SVR costs for stages F0 to F4 were estimated at 50% lower by taking the midpoint of 2 pre-SVR vs post-SVR cost ratios derived from medical care payment databases in the United States and the United Kingdom.…”

“…44,45 Post-SVR costs for stages F0 to F4 were estimated at 50% lower by taking the midpoint of 2 pre-SVR vs post-SVR cost ratios derived from medical care payment databases in the United States and the United Kingdom. 42,46 The model accounted for costs of HCV genotyping, fibrosis staging, and therapy monitoring, including clinic visits, blood and hepatic tests, and HCV RNA quantification. These costs were determined using the Medicare reimbursement schedule and published literature.…”

Reduced healthcare utilization following successful hepatitis C virus treatment in HIV‐co‐infected patients with mild liver disease

“…This is the first study to explore the impact of successful treatment in individuals with HIV co‐infection and mild disease, an important group who may play a key role in ongoing transmission of infection if not being prioritized for treatment based on liver fibrosis. Recent work has explored the benefits of treatment in HCV‐monoinfected patients , and a different cohort from the one investigated here not least because HCV‐monoinfected individuals with mild disease can potentially be discharged from secondary care after successful treatment. A UK study reported a thirteen‐fold difference in costs between SVR and non‐SVR patients with chronic hepatitis C limited to those with genotype 1 .…”