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Patient voices needed to calculate true HCV cost-effectiveness

Cost-effectiveness research and analyses of hepatitis C treatment thus far lacks patient engagement, according to a recently published literature review. These patients face a variety of negative physical, social and psychological effects that are not represented in studies focused on payer outcomes.

“Incorporating patient-engagement methods could inform the degree to which patients return to a pre-disease state or whether psychological and sociological relicts remain from years of living with the disease,” T. Joseph Mattingly II, PharmD, MBA, from the University of Maryland School of Pharmacy, and colleagues wrote.

After conducting a literature review of the SCOPUS, EMBASE and PubMed databases from Jan. 1, 2012, to May 28, 2017 using terms related to cost-effectiveness analysis and HCV, researchers found 1,040 articles, including 283 duplicates. However, only seven articles met the researchers’ criteria for patient engagement.

Among the selected articles, four involved direct patient engagement through semi-structured interviews and two included systematic reviews of patient-reported outcomes. Further, two studies were randomized controlled trials and one study focused specifically on time trade-off interviews to estimate patient-reported utility associated with treatment and adverse events. Most of the studies’ objectives did include models for quality of life assessment. Only one study used model input weighting from patient engagement.

“When searching for economic models within the HCV literature, several [cost-effectiveness analysis] studies were identified; however, most economic analyses did not include any sort of patient engagement in the methods throughout the process of determining a ‘cost effectiveness’ result,” Mattingly and colleagues wrote.

Because the International Society of Pharmaceutical Outcomes Research task force on modeling suggested that model structures focus on the “chosen decision-making perspective,” the researchers recognize that the anticipated end-user in many studies is the payer for pharmaceutical services.

“However, successful implementation of any health service also relies on the active participation of the ultimate end-user of the service, which is undoubtedly the patient,” the researchers wrote. “Shifting modeling methods to include patient input may result in more informed decision-making encompassing the factors that impact real patients dealing with the disease.” – by Talitha Bennett

Disclosure: Healio.com/Hepatology was unable to determine relevant financial disclosures at the time of publication.