Purpose: The Veterans Health Administration (VHA) is the largest single provider of hepatitis C (HCV) care in the United States. The aim of this study is to analyze cost-effectiveness of two newly approved direct acting antiviral (DAA) drugs, Boceprevir (Boc) and Telaprevir (Tel) in a cohort of 102,851 patients with untreated chronic HCV genotype 1 infection in the VHA.
Method: Decision-analytic Markov model with sensitivity analyses were used. Data sources used included published natural history progression rates, census bureau data, and current VHA pharmacy and hospitalization costs. Four strategies were compared: (1) Standard dual therapy pegylated interferon alfa and ribavirin (PR), (2) Boc/PR triple therapy (3) Tel/PR triple therapy, and (4) no treatment. In our model, patients received 1) PR for average 38 weeks, 2) Tel for 12 wks with PR for average 27 wks, or 3) Boc for average 30 wks with PR for average 35 wks. The “no treatment” strategy was the least cost-effective compared with the three treatment strategies. Estimated treatment cost associated with PR alone, Boc/PR, and Tel/PR are about $8000, $ 31,300 and $ 41,700 per average patient, respectively.
Result: With the current treatment rate of 22 %, total system-wide costs to adopt Boc/PR or Tel/PR would be $708 million and $943 million,respectively. Assuming continuation of the current 22% VHA treatment rates and optimal SVR results, the long term reduction in liver related death from treatment PR, Boc/PR, and Tel/PR are 5.2%,10.9% , and 11.5% respectively. Increasing treatment rates to 50% will result in reduction in liver related death of 12%, 24.7% and 26.1%, respectively. The incremental cost-effectiveness ratio of Boc/PR and Tel/PR versus the standard PR is 20,928 $/QALY and 33,434 $/QALY.
Conclusion: Our model indicates upfront investments with Boc/PR, and Tel/PR are high; however the benefits of improving quality of life, extending duration of life, and lowering healthcare expenditures offset the costs due to reduced liver-related morbidity. These findings indicate that these therapies are cost effective within the VHA system. Further efforts to expand access to DAA therapy are warranted.
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