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Treat-all strategy more cost effective than noninvasive tests for HCV patients

The most cost-effective strategy to determine treatment for patients with hepatitis C virus infection in the United Kingdom was to treat all patients regardless of fibrosis stage, according to new study data.

Researchers, including Emmanuel Tsochatzis MD, MSc, FEBTM, PhD, of the UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, conducted a systematic review of 162 studies involving patients with chronic hepatitis C virus (HCV) infection from various databases and a meta-analysis using a bivariate model to measure the accuracy and effectiveness of multiple noninvasive tests (NIT). The data, along with national data, was used to construct a probability model to estimate health care costs and outcomes.

Emmanuel Tsochatzis

All NITs were compared, and the cost-effectiveness of triple therapy with boceprevir or telaprevir and new antivirals were examined. Four treatment strategies were compared: testing with NITs and treating patients with a fibrosis stage of at least F2; testing with liver biopsy and treating patients with at least F2 fibrosis; treat no patients; and treat all patients regardless of fibrosis stage.

Investigators said the most cost-effective strategy was to treat all patients, resulting in an incremental cost-effectiveness ratio (ICER) of £9,204, with a quality-adjusted life-years (QALY) gain of 0.47. The approach is within the standard U.K. range for cost-effectiveness, regardless of an additional cost of £4.287, when compared with FibroSpect and FibroScan.

Exploratory analysis of sofosbuvir treatment regimens also showed treating all patients to be most cost effective (ICER, £16.028 per QALY gain) vs. NIT. Researchers said the treat-all strategy would remain the most cost-effective method if it maintained a cost threshold of £37,500.

“Treating all patients with CHC, irrespective of fibrosis stage, is the most cost-effective strategy with currently available drugs in developed countries," Tsochatzis told Healio.com/Hepatology. "This, however, might change depending on the price of upcoming treatments.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.