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Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290.

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Presentation on theme: "Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290."— Presentation transcript:

1 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Figure 1. Model schematics. The small square represents the decision to implement a policy of standard therapy, universal triple therapy, or IL-28B–guided triple therapy. The small circle with inset “M” indicates the Markov model. During each 12-wk cycle of the model, all persons face a risk for death, depending on their age, sex, race, and health state. Persons begin the model receiving treatment, and if treatment is successful (the patient achieves sustained virologic response), the patient may transition along one of the dashed arrows to a fibrosis stage—stratified, recovered state. Treatment effectiveness is determined by type of treatment, race, fibrosis stage, and IL-28B genotype. If treatment is not successful, the person continues progressing through the natural history of HCV (solid arrows). Death can occur from any health state in the Markov model. HCC = hepatocellular carcinoma; HCV = hepatitis C virus; IL-28B = interleukin-28B; PEG-IFN = pegylated interferon; PI = protease inhibitor; Rb = ribavirin. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

2 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Appendix Figure 1. Schematic of first-line response-guided therapy for standard 2-drug therapy. Sustained virologic response is the goal of treatment, and it is measured 24 wk after treatment is stopped. Early virologic response is defined as a reduction of ≥2 log 10 /mL or complete absence of serum HCV RNA at week 12 of treatment compared with the baseline level. EVR = early virologic response; HCV = hepatitis C virus; PEG-IFN = pegylated interferon; Rb = ribavirin; SVR = sustained virologic response. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

3 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Appendix Figure 2. Schematic of first-line response-guided therapy for triple therapy strategies. EVR = early virologic response; HCV = hepatitis C virus; PEG-IFN = pegylated interferon; PI = protease inhibitor; Rb = ribavirin; SVR = sustained virologic response. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

4 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Figure 2. Cost-effectiveness results: incremental costs incurred and QALYs for each intervention. The graph plots the incremental discounted QALYs (y-axis) and incremental discounted total expected lifetime costs (x-axis) for each treatment strategy separately for cohorts of patients with mild and advanced fibrosis. The solid lines represent the cost-effectiveness frontier, those strategies that are potentially cost-effective depending on one's willingness to pay per unit of health benefit gained, expressed as an incremental cost- effectiveness ratio (defined as the ratio of the additional costs of an intervention and its additional effects compared with the next-best alternative). IL-28B = interleukin-28B; QALY = quality-adjusted life-year. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

5 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Appendix Figure 3. Cost-effectiveness results, depending on the fibrosis stage of the cohort. The ICER of strategies on the efficient frontier compared with the next best strategy on the frontier, assuming protease inhibitor costs $1100 per week. ICER = incremental cost-effectiveness ratio; IL-28B = interleukin- 28B; QALY = quality-adjusted life-year. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

6 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Appendix Figure 4. Protease inhibitor scenario analysis: ICERs between universal triple therapy using telaprevir to universal triple therapy using boceprevir (base case). ADVANCE = A New Direction in HCV Care: A Study of Treatment-Naive Hepatitis C Patients with Telaprevir; ICER = incremental cost-effectiveness ratio; QALY = quality-adjusted life-year. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

7 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Appendix Figure 5. Cost-effectiveness acceptability curve, assuming protease inhibitor costs $1100 per week. The figure shows the probability of each strategy providing the maximum net monetary benefits at various willingness-to-pay thresholds. IL-28B = interleukin-28B; QALY = quality-adjusted life-year. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

8 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Appendix Figure 6. Model schematics: 5 strategies. The small square represents the decision to implement a policy of therapy. The small circle with inset “M” indicates the Markov model. IL-28B = interleukin-28B; PEG-IFN = pegylated interferon; PI = protease inhibitor; Rb = ribavirin. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

9 Date of download: 6/2/2016 From: New Protease Inhibitors for the Treatment of Chronic Hepatitis C: A Cost-Effectiveness Analysis Ann Intern Med. 2012;156(4):279-290. doi:10.7326/0003-4819-156-4-201202210-00005 Appendix Figure 7. Overall probability of SVR; by race: 100 treatment effectiveness profiles. SVR = sustained virologic response. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians


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