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N-6 THE HEPATITIS C DRUG PIPELINE: COLLABORATION BETWEEN ACADEMIC AND HTA AGENCY PARTNERS TO DEVELOP AN EARLY ECONOMIC MODEL

Wednesday, October 23, 2013: 11:15 AM
Key Ballroom 7,9,10 (Hilton Baltimore)
Health Services, and Policy Research (HSP)

William W. L. Wong, Ph.D.1, Hong Anh Tu, PhD1, Wendong Chen, MD, PhD1, Jordan J. Feld, MD, MPH1, Kristen Chelak, BSc, (Pharm), MSc, RPh2, Karen M. Lee, MA2 and Murray D. Krahn, MD, MSc3, (1)University of Toronto, Toronto, ON, Canada, (2)Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, ON, Canada, (3)Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Purpose: Prior to 2011, pegylated interferon plus ribavirin (PR) was the standard therapy for chronic hepatitis C (CHC).  In 2011, the first direct-acting antiviral agents (DAA) (boceprevir, telaprevir) were approved.  More DAA currently under development and expected to receive market approval in the next few years.  While these treatments appear to be more effective at achieving sustained virologic response in CHC patients; they are more expensive than PR and have different adverse event profile. These aspects need to be considered collectively when making reimbursement decisions.  The objective of this study is to build a flexible model platform that can evaluate the cost-effectiveness of the pipeline of hepatitis C drugs for various treatment and patient scenarios once new treatments are available.

Method: We developed a flexible state transition model of CHC.  Health states relate to treatment and adverse events, fibrosis stages (F0–F4), and CHC complications states.  Our model was divided into a treatment and a natural history modules.  The treatment module can be easily changed to reflect different treatment algorithms.  The natural history module is a robust model that reflects the natural history of CHC and was validated against other published models. Simulated population can be stratified by CHC genotype, Interleukin-28B genotype, treatment status (naïve, experienced), age, and fibrosis stages.  Disease progression parameters were from our published systematic review, which estimated the annual transition probabilities between fibrosis stages.  The CHC-related costs were from our large published costing study using administrative data.  Utility data were from our published study of CHC patients across different health states.

Result: As a preliminary test, we evaluated our model using data from the telaprevir clinical trials (ADVANCE, ILLUMINATE).  Table 1 summarizes the outcomes associated with our base-case analysis (50-years, genotype 1, treatment naïve) stratified by fibrosis stages.    Validation was done against QALY gained from other published models.  Based on the current structure, the generated ICERs are congruent with other studies.

Conclusion: Our model platform provides a robust CHC natural history model while allowing for flexibility in changing treatment algorithms.  When new agents are brought forward for approval, the model will be used to compare the relative cost-effectiveness of available CHC treatment strategies.

 
 Table1:     Fibrosis Strategy Cost QALYs ICER
Mild PR $112,534 11.36
Telaprevir $137,995 11.73 $68,228
Severe PR $111,530 10.18
Telaprevir $137,465 11.07 $29,089

See more of: RESOURCES FOR THE FUTURE: PLANNING THE COSTS OF HEALTH CARE

See more of: The 35th Annual Meeting of the Society for Medical Decision Making