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BACKGROUND:Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. OBJECTIVES:To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients. METHODS:Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies. RESULTS:The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course. CONCLUSIONS:Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective.

Original publication

DOI

10.1016/j.jval.2018.12.011

Type

Journal article

Journal

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

Publication Date

06/2019

Volume

22

Pages

693 - 703

Addresses

Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK. Electronic address: c.fawsitt@bristol.ac.uk.

Keywords

STOP-HCV Consortium, Humans, Hepacivirus, Hepatitis C, Chronic, Sulfonamides, Carbamates, Macrocyclic Compounds, Antiviral Agents, Markov Chains, Decision Trees, Cost-Benefit Analysis, State Medicine, Sofosbuvir, United Kingdom, Heterocyclic Compounds, 4 or More Rings