A systematic review of economic evidence in hepatitis c An overview of cost, utility, and cost-effectiveness data
OBJECTIVES: To perform a systematic literature review of economic evidence for genotype 1 hepatitis C virus (HCV) treatments and to summarise and assess the methods used in recent economic evaluations.
METHODS: Multiple databases were searched to identify economic evaluations in patients with genotype 1 HCV. Detailed review methods are presented elsewhere.
RESULTS: 53 economic analyses and 17 Health Technology Assessment (HTA) documents were identified. Most economic analyses were performed using lifetime horizon Markov models, all for interferon-containing regimens. Most were performed in the United Kingdom (UK) (n = 13), United States (n = 13), or Germany (n = 7). Two recent National Institute for Health and Care Excellence (NICE) submissions were included: telaprevir triple therapy (with peginterferon plus ribavirin) and boceprevir triple therapy, for previously treated and untreated patients. The models used were different; however their structures and some inputs were based on previous NICE appraisals for peginterferon plus ribavirin. There were a number of limitations found in the included economic evaluations, which may have affected the cost-effectiveness outcomes: 1) The models did not adequately capture all health benefits and costs in their quality-adjusted life-year calculations; 2) The models did not account for the possibility of benefits caused by reduced transmission of HCV; 3) The models did not incorporate patient factors that may influence disease progression; 4) Modelling of subgroups may have been insufficient, particularly as the understanding of patient and viral factors that predict treatment response grows; and 5) Some made generalisations for the compensated cirrhosis population that were not comparable with the UK population.
CONCLUSTIONS: Recent economic models have generally adhered to previous iterations of HCV models and have not evolved with our knowledge of the disease. In light of upcoming treatment alternatives, model refinement may be necessary to capture the increasingly complex treatment decisions that will be required.
Woods, MS., Kiri, S., Ling, C., McCrink, L., Zimovetz, E., & Hass, B. (2013). A systematic review of economic evidence in hepatitis c: An overview of cost, utility, and cost-effectiveness data. Value in Health, 16(7), A349.