Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6):407-419. doi:10.7326/M14-1152.

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Presentation transcript:

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M Model structure for one of the treatment groups. This diagram shows one of the treatment groups in the model. Other treatment groups have the identical structure but different values for model parameters. The model assigns baseline characteristics (age, sex, race, alcohol use, METAVIR stage score, HCV genotype, IL-28B genotype, and age-specific quality of life) to a hypothetical cohort with HCV. Patients are assigned a treatment strategy and fibrosis stage (F0, F1, F2, F3, or F4) based on their METAVIR score. In each cycle, patients follow different health trajectories depending on whether they have achieved SVR, possible subsequent complications, liver-related death, or background mortality; probabilities of each are a function of patient characteristics in that cycle. If a patient survives in a given year, the quality-adjusted life-year and total cost accrued in that year will be recorded and patient characteristics will be updated for the next cycle. All patients are followed over their lifetime. Patients will receive only 1-time treatment, and re-treatment has not been modeled. HCC = hepatocellular carcinoma; HCV = hepatitis C virus; SVR = sustained virologic response. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M Proportion of patients with no evidence of stage F0 fibrosis who developed stage F4 cirrhosis over time in the calibrated model. A cohort of recently infected patients (i.e., at stage F0 fibrosis at baseline) were simulated over their lifetime, and their progression rates to cirrhosis over time were recorded. The characteristics of this cohort were identical to our assumptions in the base-case analysis, assuming that they received no treatment for hepatitis C virus. Under the base-case assumptions, 6.4% of patients developed cirrhosis over 25 y since infection. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M Base-case results of incremental cost-effectiveness of treatment strategies versus usual care for genotypes 1 (top), 2 (middle), and 3 (bottom). The lines represent the efficient frontier. The ICERs (compared with the next best alternative) have been reported for the points on the efficient frontier. Treatment options that are not on the efficient frontiers result in larger incremental costs and smaller incremental QALYs. DCV = daclatasvir; ICER = incremental cost-effectiveness ratio; LDV = ledipasvir; PEG = pegylated interferon; QALY = quality-adjusted life-year; RBV = ribavirin; SMV = simeprevir; SOF = sofosbuvir. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M One-way sensitivity analyses on individual drug prices, identifying the threshold at which various treatment strategies become optimal in terms of net monetary benefit for genotypes 1 (top), 2 (middle), and 3 (bottom). Dotted lines represent the values used in the base-case analyses. This sensitivity analysis assumes a willingness-to-pay threshold of $ per quality-adjusted life-year. DCV = daclatasvir; LDV = ledipasvir; PEG = pegylated interferon; RBV = ribavirin; SMV = simeprevir; SOF = sofosbuvir. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M One-way sensitivity analyses on SVR, identifying the threshold at which various treatment strategies become optimal in terms of net monetary benefit for genotypes 1 (top), 2 (middle), and 3 (bottom). Dotted lines represent the values used in the base-case analyses. This sensitivity analysis assumes a willingness-to-pay threshold of $ per quality-adjusted life-year. DCV = daclatasvir; LDV = ledipasvir; PEG = pegylated interferon; RBV = ribavirin; SMV = simeprevir; SOF = sofosbuvir; SVR = sustained virologic response. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M Incremental cost-effectiveness ratio of treatment strategies versus usual care as a function of SVR rate for genotype 1 (top), 2 (middle), and 3 (bottom). Usual care for genotype 1 consisted of response-guided triple therapy using boceprevir–RBV–PEG for 28 to 48 wk. Usual care for genotypes 2 and 3 consisted of dual therapy with RBV–PEG for 24 wk. DCV = daclatasvir; LDV = ledipasvir; PEG = pegylated interferon; QALY = quality-adjusted life-year; RBV = ribavirin; SMV = simeprevir; SOF = sofosbuvir; SVR = sustained virologic response. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M ICERs as a function of baseline fibrosis stage, with results of a 1-way sensitivity analysis for genotypes 1 (top), 2 (middle), and 3 (bottom). Usual care for genotype 1 consisted of response-guided triple therapy using boceprevir−RBV−PEG for 28 to 48 wk. Usual care for genotypes 2 and 3 consisted of dual therapy with ribavirin–PEG for 24 wk. DCV = daclatasvir; ICER = incremental cost-effectiveness ratio; LDV = ledipasvir; PEG = pegylated interferon; QALY = quality-adjusted life-year; RBV = ribavirin; SMV = simeprevir; SOF = sofosbuvir. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M ICER of treatment strategies versus usual care as a function of age at treatment initiation for genotypes 1 (top), 2 (middle), and 3 (bottom). Usual care for genotype 1 consisted of response-guided triple therapy using boceprevir–RBV–PEG for 28 to 48 wk. Usual care for genotypes 2 and 3 consisted of dual therapy with ribavirin–PEG for 24 wk. Because SOF– RBV is a dominated strategy for all ages, it has not been included. DCV = daclatasvir; ICER = incremental cost-effectiveness ratio; LDV = ledipasvir; PEG = pegylated interferon; QALY = quality-adjusted life-year; RBV = ribavirin; SMV = simeprevir; SOF = sofosbuvir. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M Cost-effectiveness acceptability curve showing the optimal choices at various willingness-to-pay thresholds for genotypes 1 (top), 2 (middle), and 3 (bottom). The plots represent the results of probabilistic sensitivity analyses using a Monte Carlo simulation, and the lines show the percentage of iterations in which each strategy would be optimal at various willingness-to-pay thresholds. Usual care for genotype 1 consisted of response-guided triple therapy using boceprevir–RBV–PEG for 28 to 48 wk. Usual care for genotypes 2 and 3 consisted of dual therapy with RBV–PEG for 24 wk. DCV = daclatasvir; LDV = ledipasvir; PEG = pegylated interferon; QALY = quality-adjusted life-year; RBV = ribavirin; SMV = simeprevir; SOF = sofosbuvir. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Cost-Effectiveness of Novel Regimens for the Treatment of Hepatitis C Virus Ann Intern Med. 2015;162(6): doi: /M Results of probabilistic sensitivity analysis. Cost-effectiveness acceptability curves of treatment strategies vs. usual care. Usual care for genotype 1 consisted of response-guided triple therapy using boceprevir–RBV–PEG for 28 to 48 wk. Usual care for genotypes 2 and 3 consisted of dual therapy with RBV–PEG for 24 wk. DCV = daclatasvir; LDV = ledipasvir; PEG = pegylated interferon; QALY = quality-adjusted life-year; RBV = ribavirin; SMV = simeprevir; SOF = sofosbuvir. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

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