PIN103 – Boceprevir Use in France: A Markov Model of Disease Progression and Cost-Effectiveness for Chronic Hepatitis C (Virus G1)

The addition of boceprevir (BOC) to peginterferon–ribavirin (PR) resulted in significantly higher rates of sustained virologic response in naive or pretreated patients with the chronic hepatitis C virus (HCV) genotype 1 infection, as compared with PR alone. The objective is to project the long-term clinical benefits and estimate the cost-effectiveness of the treatment strategies recommended in the BOC label compared with PR alone. A Markov model was created to estimate the expected costs and quality adjusted life-years (QALYs) associated with the BOC tritherapy and PR. The model simulates the treatment regimens and the natural history of the chronic HCV to project the lifetime cumulative incidence of advanced liver-related diseases (decompensated cirrhosis (DC), hepatocellular carcinoma (HCC)) and liver transplant. Series of 30 cohorts representing all combinations of pre-specified patient characteristics progress through the model. The baseline characteristics used to define the cohorts are: naive/pretreated, age, gender, baseline fibrosis score and race cohort for the treatment naive population only. Separate analyses were run for naive and pretreated patients. The distribution of baseline fibrosis score for each analysis was based on the subjects enrolled in the clinical trials; the average age and distribution of race cohort were based on French observational study (F. Roudot Thoraval, ADEQUATION, AFEF 2009). The comparator was PR (48 weeks). The model predicted relative reductions in patients treated with BOC vs PR alone: 33% and 32% in DC/HCC in naive patients and also 46% and 53% in DC/HCC in pretreated patients. The ICER of BOC-based therapy compared with PR were 15,681€/QALY for naive patients and 10,563€/QALY for pretreated patients. Compared with PR, boceprevir-based treatment is projected to substantially reduce the burden of liver complications associated with the chronic hepatitis C virus genotype 1 and is highly cost-effective if a threshold of 50,000€/QALY is assumed.