Contributors: Kondili, L. A.; Romano, F.; Rolli, F. R.; Ruggeri, M.; Rosato, S.; Brunetto, M. R.; Zignego, A. L.; Ciancio, A.; Di Leo, A.; Raimondo, G.; Ferrari, C.; Taliani, G.; Borgia, G.; Santantonio, T. A.; Blanc, P.; Gaeta, G. B.; Gasbarrini, A.; Chessa, L.; Erne, E. M.; Villa, E.; Ieluzzi, D.; Russo, F. P.; 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. G.; Quaranta, M. G.; Cicchetti, A.; Craxi, A.; Vella, S.
نبذة مختصرة : We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus-infected patients: policy 1, "universal," treat all patients, regardless of fibrosis stage; policy 2, treat only "prioritized" 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 virus-infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies' cost-effectiveness. The patients' age and fibrosis stage, assumed DAA treatment cost of (sic)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 (sic)30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was (sic)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 (sic)19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post-sustained 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 ((sic)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 ...
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