Modeling cost-effectiveness and health gains of a “universal” versus “prioritized” hepatitis C virus treatment policy in a real-life cohort

Loreta A. Kondili, Federica Romano, Francesca Romana Rolli, Matteo Ruggeri, Stefano Rosato, Maurizia Rossana Brunetto, Anna Linda Zignego, Alessia Ciancio, Alfredo Di Leo, Giovanni Raimondo, Carlo Ferrari, Gloria Taliani, Guglielmo Borgia, Teresa Antonia Santantonio, Pierluigi Blanc, Giovanni Battista Gaeta, Antonio Gasbarrini, Luchino Chessa, Elke Maria Erne, Erica Villa & 22 others Donatella Ieluzzi, Francesco Paolo Russo, Pietro Andreone, Maria Vinci, Carmine Coppola, Liliana Chemello, Salvatore Madonia, Gabriella Verucchi, Marcello Persico, Massimo Zuin, Massimo Puoti, Alfredo Alberti, Gerardo Nardone, Marco Massari, Giuseppe Montalto, Giuseppe Foti, Maria Grazia Rumi, Maria Giovanna Quaranta, Americo Cicchetti, Antonio Craxì, Stefano Vella, on behalf of the PITER Collaborating Group

Research output: Contribution to journalArticle

Abstract

We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus–infected patients: policy 1, “universal,” treat all patients, regardless of fibrosis stage; policy 2, treat only “prioritized” patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus–infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies’ cost-effectiveness. The patients’ age and fibrosis stage, assumed DAA treatment cost of €15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of €30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was €8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was €19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post–sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (€15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (Hepatology 2017;66:1814–1825).

Original languageEnglish
Pages (from-to)1814-1825
Number of pages12
JournalHepatology
Volume66
Issue number6
DOIs
Publication statusPublished - Dec 1 2017

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Hepacivirus
Cost-Benefit Analysis
Health
Fibrosis
Antiviral Agents
Quality-Adjusted Life Years
Costs and Cost Analysis
Health Care Costs
Therapeutics
Hepatitis C
Liver Diseases
Cost of Illness
Gastroenterology
Insurance
Disease Progression
Patient Care
Delivery of Health Care

ASJC Scopus subject areas

  • Hepatology

Cite this

Kondili, L. A., Romano, F., Rolli, F. R., Ruggeri, M., Rosato, S., Brunetto, M. R., ... on behalf of the PITER Collaborating Group (2017). Modeling cost-effectiveness and health gains of a “universal” versus “prioritized” hepatitis C virus treatment policy in a real-life cohort. Hepatology, 66(6), 1814-1825. https://doi.org/10.1002/hep.29399

Modeling cost-effectiveness and health gains of a “universal” versus “prioritized” hepatitis C virus treatment policy in a real-life cohort. / Kondili, Loreta A.; Romano, Federica; Rolli, Francesca Romana; Ruggeri, Matteo; Rosato, Stefano; Brunetto, Maurizia Rossana; Zignego, Anna Linda; Ciancio, Alessia; Di Leo, Alfredo; Raimondo, Giovanni; Ferrari, Carlo; Taliani, Gloria; Borgia, Guglielmo; Santantonio, Teresa Antonia; Blanc, Pierluigi; Gaeta, Giovanni Battista; Gasbarrini, Antonio; Chessa, Luchino; Erne, Elke Maria; Villa, Erica; Ieluzzi, Donatella; Russo, Francesco Paolo; Andreone, Pietro; Vinci, Maria; Coppola, Carmine; Chemello, Liliana; Madonia, Salvatore; Verucchi, Gabriella; Persico, Marcello; Zuin, Massimo; Puoti, Massimo; Alberti, Alfredo; Nardone, Gerardo; Massari, Marco; Montalto, Giuseppe; Foti, Giuseppe; Rumi, Maria Grazia; Quaranta, Maria Giovanna; Cicchetti, Americo; Craxì, Antonio; Vella, Stefano; on behalf of the PITER Collaborating Group.

In: Hepatology, Vol. 66, No. 6, 01.12.2017, p. 1814-1825.

Research output: Contribution to journalArticle

Kondili, LA, Romano, F, Rolli, FR, Ruggeri, M, Rosato, S, Brunetto, MR, Zignego, AL, Ciancio, A, Di Leo, A, Raimondo, G, Ferrari, C, Taliani, G, Borgia, G, Santantonio, TA, Blanc, P, Gaeta, GB, Gasbarrini, A, Chessa, L, Erne, EM, Villa, E, Ieluzzi, D, Russo, FP, Andreone, P, Vinci, M, Coppola, C, Chemello, L, Madonia, S, Verucchi, G, Persico, M, Zuin, M, Puoti, M, Alberti, A, Nardone, G, Massari, M, Montalto, G, Foti, G, Rumi, MG, Quaranta, MG, Cicchetti, A, Craxì, A, Vella, S & on behalf of the PITER Collaborating Group 2017, 'Modeling cost-effectiveness and health gains of a “universal” versus “prioritized” hepatitis C virus treatment policy in a real-life cohort', Hepatology, vol. 66, no. 6, pp. 1814-1825. https://doi.org/10.1002/hep.29399
Kondili, Loreta A. ; Romano, Federica ; Rolli, Francesca Romana ; Ruggeri, Matteo ; Rosato, Stefano ; Brunetto, Maurizia Rossana ; Zignego, Anna Linda ; Ciancio, Alessia ; Di Leo, Alfredo ; Raimondo, Giovanni ; Ferrari, Carlo ; Taliani, Gloria ; Borgia, Guglielmo ; Santantonio, Teresa Antonia ; Blanc, Pierluigi ; Gaeta, Giovanni Battista ; Gasbarrini, Antonio ; Chessa, Luchino ; Erne, Elke Maria ; Villa, Erica ; Ieluzzi, Donatella ; Russo, Francesco Paolo ; Andreone, Pietro ; Vinci, Maria ; Coppola, Carmine ; Chemello, Liliana ; Madonia, Salvatore ; Verucchi, Gabriella ; Persico, Marcello ; Zuin, Massimo ; Puoti, Massimo ; Alberti, Alfredo ; Nardone, Gerardo ; Massari, Marco ; Montalto, Giuseppe ; Foti, Giuseppe ; Rumi, Maria Grazia ; Quaranta, Maria Giovanna ; Cicchetti, Americo ; Craxì, Antonio ; Vella, Stefano ; on behalf of the PITER Collaborating Group. / Modeling cost-effectiveness and health gains of a “universal” versus “prioritized” hepatitis C virus treatment policy in a real-life cohort. In: Hepatology. 2017 ; Vol. 66, No. 6. pp. 1814-1825.
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T1 - Modeling cost-effectiveness and health gains of a “universal” versus “prioritized” hepatitis C virus treatment policy in a real-life cohort

AU - Kondili, Loreta A.

AU - Romano, Federica

AU - Rolli, Francesca Romana

AU - Ruggeri, Matteo

AU - Rosato, Stefano

AU - Brunetto, Maurizia Rossana

AU - Zignego, Anna Linda

AU - Ciancio, Alessia

AU - Di Leo, Alfredo

AU - Raimondo, Giovanni

AU - Ferrari, Carlo

AU - Taliani, Gloria

AU - Borgia, Guglielmo

AU - Santantonio, Teresa Antonia

AU - Blanc, Pierluigi

AU - Gaeta, Giovanni Battista

AU - Gasbarrini, Antonio

AU - Chessa, Luchino

AU - Erne, Elke Maria

AU - Villa, Erica

AU - Ieluzzi, Donatella

AU - Russo, Francesco Paolo

AU - Andreone, Pietro

AU - Vinci, Maria

AU - Coppola, Carmine

AU - Chemello, Liliana

AU - Madonia, Salvatore

AU - Verucchi, Gabriella

AU - Persico, Marcello

AU - Zuin, Massimo

AU - Puoti, Massimo

AU - Alberti, Alfredo

AU - Nardone, Gerardo

AU - Massari, Marco

AU - Montalto, Giuseppe

AU - Foti, Giuseppe

AU - Rumi, Maria Grazia

AU - Quaranta, Maria Giovanna

AU - Cicchetti, Americo

AU - Craxì, Antonio

AU - Vella, Stefano

AU - on behalf of the PITER Collaborating Group

PY - 2017/12/1

Y1 - 2017/12/1

N2 - We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus–infected patients: policy 1, “universal,” treat all patients, regardless of fibrosis stage; policy 2, treat only “prioritized” patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus–infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies’ cost-effectiveness. The patients’ age and fibrosis stage, assumed DAA treatment cost of €15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of €30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was €8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was €19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post–sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (€15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (Hepatology 2017;66:1814–1825).

AB - We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus–infected patients: policy 1, “universal,” treat all patients, regardless of fibrosis stage; policy 2, treat only “prioritized” patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus–infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies’ cost-effectiveness. The patients’ age and fibrosis stage, assumed DAA treatment cost of €15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of €30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was €8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was €19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post–sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (€15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (Hepatology 2017;66:1814–1825).

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