Author information
1Inserm U995, Université Lille 2 - Lille Nord de France, Lille, France; "Decision Sciences in Infectious Disease: Prevention, Control, and Care", IAME, UMR 1137, Inserm; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: sylvie.burban@inserm.fr.
2"Decision Sciences in Infectious Disease: Prevention, Control, and Care", IAME, UMR 1137, Inserm; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: schwarzi@u-pec.fr.
3"Decision Sciences in Infectious Disease: Prevention, Control, and Care", IAME, UMR 1137, Inserm; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: dorotheeobach@yahoo.fr.
4Unité d'Hépatologie, Assistance Publique - Hôpitaux de Paris, Groupe hospitalier Cochin Saint Vincent de Paul, Université Paris Descartes, Paris, France; Institut Cochin, Université Paris Descartes, Inserm U1016, CNRS UMR 8104, Paris, France; Inserm U1016, Université Paris Descartes, Paris, France; Lingha Systems, Paris Biotech Santé, Paris, France. Electronic address: vincent.mallet@cch.aphp.fr.
5Unité d'Hépatologie, Assistance Publique - Hôpitaux de Paris, Groupe hospitalier Cochin Saint Vincent de Paul, Université Paris Descartes, Paris, France; Institut Cochin, Université Paris Descartes, Inserm U1016, CNRS UMR 8104, Paris, France; Inserm U1016, Université Paris Descartes, Paris, France. Electronic address: stanislas.pol@cch.aphp.fr.
6Service des Maladies de l'Appareil digestif, Hôpital Saint Eloi, Montpellier, France. Electronic address: gp-pageaux@chu-montpellier.fr.
7Service des Maladies de l'Appareil digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, France. Electronic address: valerie.canva@chru-lille.fr.
8Service de gastro-entérologie et d'hépatologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Electronic address: pierre.deltenre@skynet.be.
9Service Santé publique, Hôpital Henri Mondor, Créteil, France. Electronic address: francoise.roudot-thoraval@hmn.aphp.fr.
10Service des Maladies de l'Appareil digestif, Hôpital Saint Eloi, Montpellier, France. Electronic address: dom-larrey@chu-montpellier.fr.
11Inserm U955, Physiopathologie et Thérapeutique des Hépatites virales chroniques, Hôpital Henri-Mondor, Créteil, France. Electronic address: daniel.dhumeaux@gmail.com.
12Inserm U995, Université Lille 2 - Lille Nord de France, Lille, France; Service des Maladies de l'Appareil digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, France. Electronic address: philippe.mathurin@chru-lille.fr.
13"Decision Sciences in Infectious Disease: Prevention, Control, and Care", IAME, UMR 1137, Inserm; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Maladies infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France. Electronic address: yazdan.yazdanpanah@bch.aphp.fr.
Abstract
BACKGROUND & AIMS:
In treatment-naive patients mono-infected with genotype 1 chronic HCV, treatments with telaprevir/boceprevir (TVR/BOC)-based triple therapy are standard-of-care. However, more efficacious direct-acting antivirals (IFN-based new DAAs) are available and interferon-free (IFN-free) regimens are imminent (2015).
METHODS:
A mathematical model estimated quality-adjusted life years, cost and incremental cost-effectiveness ratios of (i) IFN-based new DAAs vs. TVR/BOC-based triple therapy; and (ii) IFN-based new DAAs initiation strategies, given that IFN-free regimens are imminent. The sustained virological response in F3-4/F0-2 was 71/89% with IFN-based new DAAs, 85/95% with IFN-free regimens, vs. 64/80% with TVR/BOC-based triple therapy. Serious adverse events leading to discontinuation were taken as: 0-0.6% with IFN-based new DAAs, 0% with IFN-free regimens, vs. 1-10% with TVR/BOC-based triple therapy. Costs were €60,000 for 12 weeks of IFN-based new DAAs and two times higher for IFN-free regimens.
RESULTS:
Treatment with IFN-based new DAAs when fibrosis stage ⩾F2 is cost-effective compared to TVR/BOC-based triple therapy (€37,900/QALY gained), but not at F0-1 (€103,500/QALY gained). Awaiting the IFN-free regimens is more effective, except in F4 patients, but not cost-effective compared to IFN-based new DAAs. If we decrease the cost of IFN-free regimens close to that of IFN-based new DAAs, then awaiting the IFN-free regimen becomes cost-effective.
CONCLUSIONS:
Treatment with IFN-based new DAAs at stage ⩾F2 is both effective and cost-effective compared to TVR/BOC triple therapy. Awaiting IFN-free regimens and then treating regardless of fibrosis is more efficacious, except in F4 patients; however, the cost-effectiveness of this strategy is highly dependent on its cost.