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doi: 10.1097/QAD.0000000000000093
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The cost-effectiveness of improved hepatitis C virus therapies in HIV/hepatitis C virus coinfected individuals.

Linas, Benjamin P.; Barter, Devra M.; Leff, Jared A.; Dilorenzo, Madeline; Schackman, Bruce R.; Horsburgh, Charles R.; Assoumou, Sabrina A.; Salomon, Joshua A.; Weinstein, Milton C.; Kim, Arthur Y.; Freedberg, Kenneth A.

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Objectives: To evaluate the effectiveness and cost-effectiveness of strategies to treat hepatitis C virus (HCV) in HIV/HCV coinfected patients in the United States.

Participants: Simulated cohort of HIV/HCV genotype 1 coinfected, noncirrhotic, HCV treatment-naive individuals enrolled in US HIV guideline-concordant care.

Design/interventions: Monte Carlo simulation comparing five strategies: no treatment; dual therapy with pegylated-interferon (PEG) and ribavirin (RBV); 'PEG/RBV trial' in which all patients initiate dual therapy and switch to triple therapy upon failure; 'IL28B triage' in which patients initiate either dual therapy or triple therapy based on their IL28B allele type; and PEG/RBV and telaprevir (TPV) triple therapy. Sensitivity analyses varied in efficacies and costs and included a scenario with interferon (IFN)-free therapy.

Main measures: Measures were sustained virologic response (SVR), life expectancy, discounted quality-adjusted life expectancy (QALE), and lifetime medical cost, and incremental cost-effectiveness ratios (ICERs) in $/quality-adjusted life years (QALY) gained.

Results: 'PEG/RBV trial,' 'IL28B triage,' and 'triple therapy' each provided 72% SVR and extended QALE compared with 'dual therapy' by 1.12, 1.14, and 1.15 QALY respectively. The ICER of 'PEG/RBV trial' compared with 'dual therapy' was $37 500/QALY. 'IL28B triage' and 'triple therapy' provided little benefit compared with 'PEG/RBV trial' and had ICERs exceeding $300 000/QALY. In sensitivity analyses, IFN-free treatment attaining 90% SVR had an ICER less than $100 000/QALY compared with 'PEG/RBV trial' when its cost was $109 000 or less (125% of the cost of PEG/RBV/TVR).

Conclusion: HCV protease inhibitors are most efficiently used in HIV/HCV coinfection after a trial of PEG/RBV, sparing protease inhibitor for those who attain rapid virologic response and SVR. The cost-effectiveness of IFN-free regimens for HIV/HCV will depend on the cost of these therapies.

(C) 2014 Lippincott Williams & Wilkins, Inc.


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