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Cost-Effectiveness of Testing for NS5A Resistance to Optimize Treatment of Elbasvir/Grazoprevir for Chronic Hepatitis C in China

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单位: [1]Huazhong Univ Sci & Technol, Tongji Hosp, Dept Pharm, Tongji Med Coll, Wuhan, Peoples R China [2]Huazhong Univ Sci & Technol, Union Hosp, Dept Pharm, Tongji Med Coll, Wuhan, Peoples R China [3]Shanghai Jiao Tong Univ, Ren Ji Hosp, Dept Pharm, Sch Med, Shanghai, Peoples R China [4]Fudan Univ, Huashan Hosp, Dept Infect Dis, Shanghai, Peoples R China [5]Monash Univ Malaysia, Sch Pharm, Kuala Lumpur, Malaysia [6]Natl Univ Singapore, Saw Swee Hock Sch Publ Hlth, Singapore, Singapore
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关键词: cost-effectiveness baseline testing resistance-associated polymorphisms elbasvir grazoprevir hepatitis C virus

摘要:
Objectives: Baseline presence of nonstructural protein 5A (NS5A) resistance-associated variants can attenuate the efficacy of new direct-acting antivirals. A potential method to attain the higher efficacy would be to screen for NS5A polymorphisms prior to the initiation of therapy and to adjust the treatment length based on the test results. However, baseline testing adds additional costs and it is unclear whether this would represent a high value strategy for chronic hepatitis C in China. Methods: A hybrid model compared 1) standard 12-weeks treatment (no testing), 2) shortened 8-weeks treatment (no testing), and 3) baseline testing with 12-/8-weeks treatment for those with/without NS5A polymorphisms from a lifetime Chinese health care payer perspective. All model inputs were retrieved from clinical trials and publically available literature. And sensitivity analyses were also conducted to assess the impact of uncertainty. Results: Baseline testing was associated with overall increase in total health care cost of USD 13.50 and in QALYs of 0.002 compared with standard 12-weeks treatment (no testing), yielded in an ICER of USD 6750/QALY gained. Scenario analyses suggested that shortened 8-weeks treatment (no testing) was found to be lower costs and great QALYs compared with other two strategies when the sustained virologic response (SVR) rate increased to 95%. Sensitivity analyses indicated that the results were robust. Conclusions: Our results suggest prior assessment of NS5A sensitivity followed by optimizing treatment duration was an economic strategy. In addition, shortened 8-weeks treatment (no testing) was shown to be dominant with the SVR rate increased to 95%.

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出版当年[2020]版:
大类 | 2 区 医学
小类 | 2 区 药学
最新[2025]版:
大类 | 3 区 医学
小类 | 3 区 药学
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出版当年[2019]版:
Q1 PHARMACOLOGY & PHARMACY
最新[2023]版:
Q1 PHARMACOLOGY & PHARMACY

影响因子: 最新[2023版] 最新五年平均 出版当年[2019版] 出版当年五年平均 出版前一年[2018版] 出版后一年[2020版]

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第一作者单位: [1]Huazhong Univ Sci & Technol, Tongji Hosp, Dept Pharm, Tongji Med Coll, Wuhan, Peoples R China
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通讯机构: [5]Monash Univ Malaysia, Sch Pharm, Kuala Lumpur, Malaysia [6]Natl Univ Singapore, Saw Swee Hock Sch Publ Hlth, Singapore, Singapore
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