COST-EFFECTIVENESS ANALYSIS OF INNOVATIVE TRIPLE THERAPY WITH PROTEASE INHIBITORS IN TREATMENT-NAïVE PERSONS WITH HEPATITIS C USING A STOCHASTIC AGENT-BASED MODEL

Purpose: Hepatitis C virus (HCV) protease inhibitors in combination with pegylated interferon and ribavirin (PEG-IFN/RBV) is the new standard of care treatment for persons infected with HCV genotype 1. Despite treatment advances for hepatitis C, treatment uptake has remained low in Australia. Our objectives were to simulate the spread of HCV and HIV infections in Australia, and assess the burden of disease and cost-effectiveness of innovative triple therapy in treatment-naïve persons with HCV over a lifetime from a societal perspective. 

Method: We developed a stochastic agent-based model. An artificial population of 10,000 agents with demographic and behavioral characteristics was created to represent the population of Australia. Contacts between the agents were based on mixing groups according to an agent’s personal and behavioral characteristics. The probability of infection in a given period of time was determined by the number of contacts, transmission probability per contact established, susceptibility of the observed agent, and the infectivity of the contacted agent. The HCV model describes the progression of HCV stages: acute HCV; fibrosis stages 0-4, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related death. Treatment scenarios include: i) dual therapy (PEG-IFN/RBV); ii) response-guided dual therapy (RGT); iii) triple therapy with boceprevir and iv) triple therapy with telaprevir for persons with HCV genotype 1. Model calibration, uncertainty and sensitivity analyses were performed. An economic model was developed to conduct cost-utility analysis. Outcomes included numbers of HCV infections averted, lifetime health care costs, quality-adjusted life year (QALY), and incremental cost-effectiveness ratios.

Result: In 2010, approximately 4,000 persons with hepatitis C were treated with standard dual therapy. Our model estimated that there were approximately 10,000 new cases of hepatitis C, 560 new cases of decompensated cirrhosis, 143 new cases of hepatocellular carcinoma, 42 liver transplant cases, and 347 liver-related deaths. Over the lifetime with the same treatment rates, these new cases would relatively increase between 37-116% under standard dual therapy. Compared to standard dual therapy, there would be a significant decline in the number of new advanced cases and the number of persons receiving liver transplantation in triple therapies, QALY gains, and cost savings in both triple therapies and RGT.

Conclusion: Both triple therapies and response-guided therapy are cost saving. Strategies to improve new treatment uptake are critical to mitigate the future burden of hepatitis C.