Modeling cost-effectiveness and health gains of a âuniversalâ versus âprioritizedâ hepatitis C virus treatment policy in a real-life cohort
| Autor: | Kondili, La, Romano, F, Rolli, Fr, Ruggeri, M, Rosato, S, Brunetto, Mr, Zignego, Al, Ciancio, A, Di Leo, A, Raimondo, G, Ferrari, C, Taliani, G, Borgia, G, Santantonio, Ta, Blanc, P, Gaeta, Gb, Gasbarrini, A, Chessa, L, Erne, Em, Villa, E, Ieluzzi, D, Russo, Fp, Andreone, P, Vinci, M, Coppola, C, Chemello, L, Madonia, S, Verucchi, G, Persico, M, Zuin, M, Puoti, M, Alberti, A, Nardone, G, Massari, M, Montalto, G, Foti, G, Rumi, Mg, Quaranta, Mg, Cicchetti, A, Craxì, A, Vella, S, PITER Collaborating Group |
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| Přispěvatelé: | Kondili, Loreta A., Romano, Federica, Rolli, Francesca Romana, Ruggeri, Matteo, Rosato, Stefano, Brunetto, Maurizia Rossana, Zignego, Anna Linda, Ciancio, Alessia, Di Leo, Alfredo, Raimondo, Giovanni, Ferrari, Carlo, Taliani, Gloria, Borgia, Guglielmo, Santantonio, Teresa Antonia, Blanc, Pierluigi, Gaeta, Giovanni Battista, Gasbarrini, Antonio, Chessa, Luchino, Erne, Elke Maria, Villa, Erica, Ieluzzi, Donatella, Russo, Francesco Paolo, Andreone, Pietro, Vinci, Maria, Coppola, Carmine, Chemello, Liliana, Madonia, Salvatore, Verucchi, Gabriella, Persico, Marcello, Zuin, Massimo, Puoti, Massimo, Alberti, Alfredo, Nardone, Gerardo, Massari, Marco, Montalto, Giuseppe, Foti, Giuseppe, Rumi, Maria Grazia, Quaranta, Maria Giovanna, Cicchetti, Americo, Craxì, Antonio, Vella, Stefano, Kondili, L, Romano, F, Rolli, F, Ruggeri, M, Rosato, S, Brunetto, M, Zignego, A, Ciancio, A, Di Leo, A, Raimondo, G, Ferrari, C, Taliani, G, Borgia, G, Santantonio, T, Blanc, P, Gaeta, G, Gasbarrini, A, Chessa, L, Erne, E, Villa, E, Ieluzzi, D, Russo, F, Andreone, P, Vinci, M, Coppola, C, Chemello, L, Madonia, S, Verucchi, G, Persico, M, Zuin, M, Puoti, M, Alberti, A, Nardone, G, Massari, M, Montalto, G, Foti, G, Rumi, M, Quaranta, M, Cicchetti, A, Craxì, A, Vella, S, Kondili LA1, Romano F2, Rolli FR2, Ruggeri M2, Rosato S1, Brunetto MR3, Zignego AL4, Ciancio A5, Di Leo A6, Raimondo G7, Ferrari C8, Taliani G9, Borgia G10, Santantonio TA11, Blanc P12, Gaeta GB13, Gasbarrini A2, Chessa L14, Erne EM15, Villa E16, Ieluzzi D17, Russo FP15, Andreone P18, Vinci M19, Coppola C20, Chemello L15, Madonia S21, Verucchi G18, Persico M22, Zuin M23, Puoti M19, Alberti A15, Nardone G13, Massari M24, Montalto G25, Foti G26, Rumi MG23, Quaranta MG1, Cicchetti A2, Craxì Antonio, Vella S1, PITER Collaborating Group. |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
hepatitis C virus
Pediatrics Cost effectiveness Viral Hepatitis Adult Aged Aged 80 and over Antiviral Agents Cohort Studies Cost-Benefit Analysis Health Policy Hepatitis C Humans Middle Aged Young Adult Models Economic Hepatology Direct-acting antiviral Liver disease 0302 clinical medicine Models Health care antiviral therapy 80 and over incremental cost-effectiveness ratio health care economics and organizations HCV cost -effectiveness Direct-acting antiviral hepatocellular carcinoma hepatitis C virus incremental cost-effectiveness ratio interferon quality-adjusted life-years sustained virological response willingness to pay Cost–benefit analysis 030503 health policy & services quality-adjusted life-years hepatocellular carcinoma interferon HCV cost-effectiveness real-life cohort Cohort 030211 gastroenterology & hepatology Original Article sustained virological response 0305 other medical science Cohort study Human medicine.medical_specialty Economic NO 03 medical and health sciences medicine Cost-Benefit Analysi Health policy Antiviral Agent business.industry Original Articles medicine.disease Surgery Cohort Studie business willingness to pay |
| Zdroj: | Hepatology (Baltimore, Md.) |
| Popis: | We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virusâinfected patients: policy 1, âuniversal,â treat all patients, regardless of fibrosis stage; policy 2, treat only âprioritizedâ patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virusâinfected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policiesâ cost-effectiveness. The patientsâ age and fibrosis stage, assumed DAA treatment cost of â¬15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of â¬30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was â¬8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was â¬19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 postâsustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (â¬15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (Hepatology 2017;66:1814â1825). |
| Databáze: | OpenAIRE |
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