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OBJECTIVES:Direct-acting antivirals containing nonstructural protein 5A (NS5A) inhibitors administered over 8 to 12 weeks are effective in ∼95% of patients with hepatitis C virus. Nevertheless, patients resistant to NS5A inhibitors have lower cure rates over 8 weeks (<85%); for these patients, 12 weeks of treatment produces cure rates greater than 95%. We evaluated the lifetime cost-effectiveness of testing for NS5A resistance at baseline and optimizing treatment duration accordingly in genotype 1 noncirrhotic treatment-naïve patients from the perspective of the UK National Health Service. METHODS:A decision-analytic model compared (1) standard 12-week treatment (no testing), (2) shortened 8-week treatment (no testing), and (3) baseline testing with 12-/8-week treatment for those with/without NS5A polymorphisms. Patients who failed first-line therapy were retreated for 12 weeks. Model inputs were derived from published studies. Costs, quality-adjusted life-years, and the probability of cost-effectiveness were calculated. RESULTS:Baseline testing had an incremental net monetary benefit (INMB) of £11 838 versus standard 12 weeks of therapy (no testing) and low probability (31%) of being the most cost-effective, assuming £30 000 willingness to pay. Shortened 8 weeks of treatment (no testing) had an INMB of £12 294 and the highest probability (69%) of being most cost-effective. Scenario analyses showed baseline testing generally had the highest INMB and probability of being most cost-effective if first- and second-line drug prices were low (<£20k). CONCLUSIONS:Optimizing treatment duration based on NS5A polymorphisms for genotype 1 noncirrhotic treatment-naive patients in the United Kingdom is not cost-effective if the drug costs are high; the strategy is generally most cost-effective when drug prices are low (<£20k).

Original publication

DOI

10.1016/j.jval.2019.08.012

Type

Journal article

Journal

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

Publication Date

02/2020

Volume

23

Pages

180 - 190

Addresses

Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK. Electronic address: c.fawsitt@bristol.ac.uk.

Keywords

STOP HCV Consortium, Humans, Hepacivirus, Hepatitis C, Chronic, Viral Nonstructural Proteins, Antiviral Agents, Treatment Outcome, Molecular Diagnostic Techniques, Models, Economic, Markov Chains, Predictive Value of Tests, Drug Resistance, Viral, Genotype, Polymorphism, Genetic, Decision Support Techniques, Decision Trees, Quality-Adjusted Life Years, Time Factors, Adult, Cost-Benefit Analysis, Drug Costs, State Medicine, Female, Male, Molecular Targeted Therapy, United Kingdom