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Cost-effectiveness analysis of sofosbuvir-based regimens for chronic hepatitis C
  1. Ramón San Miguel1,
  2. Vicente Gimeno-Ballester2,
  3. Antonio Blázquez3,
  4. Javier Mar4
  1. 1Department of Pharmacy, Complejo Hospitalario de Navarra, Pamplona, Spain
  2. 2Department of Pharmacy, Hospital Universitario Miguel Servet, Zaragoza, Spain
  3. 3Department of Medicines for Human Use, Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
  4. 4Clinical Management Service, Hospital Alto Deba, Mondragon, Spain
  1. Correspondence to Dr Ramón San Miguel, Department of Pharmacy, Complejo Hospitalario de Navarra, C/ Irunlarrea 3, Pamplona 31008, Spain; rsanmige{at}navarra.es

Abstract

Background A new scenario of therapy for chronic hepatitis C (CHC) is being established with the approval of sofosbuvir (SOF).

Objective To estimate the cost-effectiveness of SOF-based regimens approved in the Summary of Product Characteristics (SmPC) versus the standard of care for different genotypes and patient populations (naive or pretreated).

Methods A Markov model simulating CHC progression was used to estimate disease treatment costs and effects over patients’ lifetimes, from the Spanish National Public Healthcare System perspective. Different therapeutic options were analysed for genotypes 1, 2 and 3 in naive population and for genotype 2 and 3 pretreated patients, according to data obtained from clinical trials. A one-way sensitivity analysis was performed to evaluate the uncertainty of certain parameters: treatment starting age, transition probabilities, drug costs and discount rate. A probabilistic sensitivity analysis was also carried out.

Results For the naive population, the option SOF+pegylated-interferon-α (pIFN)+ribavirin (RBV) for 12 weeks recorded in SmPC for genotype 1 and 3 versus pIFN+RBV for 24 weeks estimated an incremental cost-effectiveness ratio (ICER) below the €40 000/quality-adjusted life-year (QALY) benchmark. For the pretreated population, SOF triple therapy reached an ICER on the threshold limit for genotype 3. Other options included in SmPC for different genotypes exceeded the accepted efficiency limit in our setting.

Conclusions The options that included SOF+RBV+pIFN in a 12-week course regimen fell below the efficiency threshold considered in our setting. IFN-free regimens administered for 24 weeks reached figures over the benchmark of €40 000/QALY.

  • CHRONIC HEPATITIS
  • COST-EFFECTIVENESS
  • HCV

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