Telaprevir cost-effectiveness abstract selected as newsworthy, presented at 2011 Liver Meeting

Ziad Gellad, MD, assistant professor medicine (Gastroenterology) shares this news: Our abstract on the cost-effectiveness of telaprevir for hepatitis C was selected as one of 10 abstracts out of 2300 that was presented to the press by the president of the American Association for the Study of Liver Diseases at the 2011 Liver Meeting in San Francisco this year. [toggle title_open="Close Me" title_closed="View the abstract" hide="yes" border="yes" style="default" excerpt_length="0" read_more_text="Read More" read_less_text="Read Less" include_excerpt_html="no"]The Cost-Effectiveness of a Telaprevir-Inclusive Regimen as Initial Therapy for Genotype 1 Hepatitis C Infection in Individuals with the CC IL-28B Polymorphism. Z. F. Gellad1, 2; S. Naggie1, 2; S. D. Reed1, 2; P. J. Clark1; A. J. Thompson1, 3; K. A. Schulman1, 2; A. J. Muir1, 2 1. Duke Clinical Research Institute, Durham, NC, United States. 2. Department of Medicine, Duke University Medical Center, Durham, NC, United States. 3. St. Vincent's Hospital, Melbourne, VIC, Australia. BACKGROUND: The increased cost of Hepatitis C therapy associated with direct-acting antiviral drugs may be minimized by tailoring therapy based on pre-treatment factors. Favorable response IL-28B genotype (C/C) is the strongest pretreatment predictor of SVR. The aim of this study was to evaluate the cost effectiveness of telaprevir as first line therapy in patients with the CC IL-28B polymorphism with genotype 1. METHODS: We developed a decision model that evaluated three treatment strategies: the first modeled 48 weeks of pegylated interferon alfa and ribavirin (Peg/RBV); in the second strategy (Peg/RBV RGT), Peg/RBV duration was 24 weeks in individuals with a rapid virologic response; in the third strategy (Telaprevir RGT), individuals received 12 weeks of telaprevir in combination with 24 or 48 weeks of Peg/RBV based on the extended rapid virologic response (eRVR). In both of the Peg/RBV strategies, non-responders and relapsers were re-treated with 48 weeks of a telaprevir-inclusive regimen. Lifetime costs and quality-adjusted life-years (QALYs) were estimated using a Markov model comparing the three treatment strategies. We performed multiple sensitivity analyses to assess parameter uncertainty and to test the impact of changes to model assumptions. All costs and benefits were discounted at a rate of 3% per year. RESULTS: The results of the base case analysis describing cost, QALYs, and the incremental cost effectiveness ratio (ICER) are presented below. Telaprevir RGT therapy is dominated by the Peg/RBV strategy. In a probabilistic sensitivity analysis, telaprevir was less likely than Peg/RBV to be cost-effective across all levels of willingness to pay thresholds. One-way sensitivity analyses revealed that telaprevir became the preferred strategy in a number of scenarios, including: when the telaprevir cost fell to less than $1,640/week (base case $3,321); when the likelihood of sustained virologic response (SVR) in non-eRVR patients rose above 80% (base case 67%); and when the likelihood of SVR in relapsers retreated with telaprevir fell to less than 62% (base case 88%). CONCLUSIONS: In genotype 1 patients with the CC IL-28B polymorphism, initial therapy with a telaprevir-based regimen is unlikely to be cost effective under current cost and efficacy conditions. Comparative effectiveness trials should consider protease inhibitor-free strategies as first line therapy in individuals with favorable IL-28B genotype.

Strategy	Cost (SE)	QALYs (SE)	ICER
Peg/RBV RGT	$46,785 (946)	19.26 (0.80)
Peg/RBV	$54,931 (867)	19.38 (0.82)	$65,051/QALY
Telaprevir RGT	$68,788 (1464)	19.34 (0.86)	(Dominated)

[/toggle] We analyzed the cost effectiveness of newly-approved telaprevir as first line therapy in treatment-naïve genotype 1 patients who have the "CC" type IL-28B polymorphism. We found that initial therapy with a telaprevir-based regimen is unlikely to be cost effective under current cost and efficacy conditions. This was presented at the presidential plenary session on 11/7/2011. Dr. Gellad used the Submit your news form – you can, too! Please share your news today.