Value of Sustained Virologic Response in Patients with Hepatitis C as a Function of Time to Progression of End-Stage Liver ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-09-01

AUTHORS

Thomas Ward, Jason Gordon, Beverley Jones, Hayley Bennett, Samantha Webster, Anupama Kalsekar, Yong Yuan, Michael Brenner, Phil McEwan

ABSTRACT

BackgroundTargeted intervention in patients with hepatitis C virus (HCV) closest to end-stage liver disease (ESLD) progression may offer an approach to treatment prioritisation whilst delivering benefits for patients and the healthcare system. In contrast to previous HCV economic analyses, this study aimed to estimate the health economic value of sustained virologic response (SVR) stratified by the patient’s propensity to progress to ESLD.MethodsAn HCV natural history model was adapted to estimate the value of avoiding ESLD complications following SVR, assessed as cost offsets and quality-adjusted life year (QALY) gains, as a function of time to ESLD at treatment initiation. These outcomes were used to estimate the financial value of achieving SVR, defined as the maximum investment that could be allocated without exceeding a willingness-to-pay threshold of £20,000/QALY.ResultsRegardless of time to ESLD onset, achieving SVR was beneficial, resulting in cost offsets and QALY gains, due to avoidance of ESLD complications. The value of achieving SVR was greatest in patients closest to ESLD onset, resulting in increased cost offsets and QALY gains (up to £50,901 and 9.56 QALYs). In patients closest to ESLD onset, the financial value of achieving SVR was £242,051, compared with £127,116 in patients furthest from onset.ConclusionsStandard cost-effectiveness evaluations may underestimate the value of treatment in HCV patients closest to ESLD development. Targeted intervention would promote efficient allocation of limited healthcare resources and reconcile concerns surrounding the affordability of new direct-acting antivirals, by minimising the number-needed-to-treat to maximise health benefit, whilst minimising healthcare expenditure. More... »

PAGES

61-70

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s40261-016-0458-z

DOI

http://dx.doi.org/10.1007/s40261-016-0458-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1001393858

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27587071


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