Analisi di cost-consequence della duplice e triplice terapia nel trattamento dell’epatite cronica di tipo C genotipo 1 in pazienti adulti naïve con fibrosi F0–F2

A recent meta-analysis pointed out that pegylated interferon α-2a is more effective than peginterferon α-2b in terms of rapid virological response (RVR) in the treatment of chronic hepatitis C (CHC). Considering the availability of triple therapy (TT—pegylated interferon, ribavirin and protease inhibitor) and the possibility to follow different treatment algorithms based on RVR achievement, verified after a 4 week lead-in period of dual therapy (DT—pegylated interferon and ribavirin), rational decisions, taking into account also economic implications, become particularly important, especially in a healthcare cost containment context. To compare the overall treatment cost in function of the decision to start the DT 4 week lead-in period with pegylated interferon α-2a plus ribavirin or with pegylated interferon α-2b plus ribavirin in the treatment of previously untreated adults (>18 years) with CHC genotype 1 and F0–F2 liver fibrosis. A cost-consequence analysis from the Italian National Health Service (NHS) perspective using two decision tree models was carried out. We considered the TT with boceprevir in the first model and the TT with telaprevir in the second. Probabilities of each event were derived from literature and an expert panel. Direct medical costs were obtained from official sources (€2013). In the boceprevir model, the average cost per patient starting the treatment with pegylated interferon α-2a plus ribavirin was estimated to be €21,570.06; the cost was estimated to be €22,060.00, starting the treatment with pegylated interferon α-2b plus ribavirin. In the telaprevir model, the average cost per patient starting the treatment with pegylated interferon α-2a plus ribavirin was estimated to be €24,320.35; the cost was estimated to be €25,696.43, starting the treatment with pegylated interferon α-2b plus ribavirin. The sensitivity analysis confirmed the results of the base case. We performed a cost consequence analysis focused on the economic implications of starting the DT 4 week lead-in period either with peginterferon α-2a or α-2b and, based on the RVR status, the consequent DT or TT therapy continuation, in the therapeutic management of CHC genotype 1 patients. Regardless of the protease inhibitor administered, from the Italian NHS perspective, starting the treatment with pegylated interferon α-2a plus ribavirin is a cost-saving strategy compared with starting with pegylated interferon α-2b plus ribavirin.