Cost-effectiveness analysis of antiviral treatment in liver transplant recipients with HCV infection
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Cost-effectiveness analysis of antiviral treatment in liver transplant recipients with HCV infection. / Logge, Christoph; Vettorazzi, Eik; Fischer, Lutz; Nashan, Björn; Sterneck, Martina.
In: TRANSPL INT, Vol. 26, No. 5, 01.05.2013, p. 527-34.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Cost-effectiveness analysis of antiviral treatment in liver transplant recipients with HCV infection
AU - Logge, Christoph
AU - Vettorazzi, Eik
AU - Fischer, Lutz
AU - Nashan, Björn
AU - Sterneck, Martina
N1 - © 2013 The Authors Transplant International © 2013 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.
PY - 2013/5/1
Y1 - 2013/5/1
N2 - Within 5-10 years, 20-40% of hepatitis C virus (HCV)-infected liver transplant recipients can be expected to develop cirrhosis. Here, cost-effectiveness of antiviral therapy was assessed. A Markov model was developed to simulate disease progression and calculate outcome and costs of treatment. In the baseline analysis, Peg-IFN/RBV treatment prevented organ loss/death, gained quality-adjusted life-years (QALYs) and undercut the limit of cost-effectiveness of €50 000/QALY with an incremental cost-effectiveness ratio of approximately €40 400/QALY and €21 000/QALY for HCV genotype 1 and 2/3 patients, respectively. Furthermore, sensitivity analysis testing modified model parameters according to extreme data described in the literature confirmed cost-effectiveness for a lower or higher rate of fibrosis progression, increased non-HCV-related mortality, lower limits of utilities, a time horizon of 30 years, and additional costs in the year of death. On the other hand, cost-effectiveness was lost for patients with genotype 1 in case of doubled antiviral or life-time costs or an increased discount rate of 7%. New treatment strategies for HCV genotype 1 infected patients remained on the same level cost-effective, if additional costs did not exceed €10 774 per 10% sustained virologic response gain. We conclude that Peg-IFN/RBV treatment is cost-effective post transplant. This may support treatment decision in individual cases.
AB - Within 5-10 years, 20-40% of hepatitis C virus (HCV)-infected liver transplant recipients can be expected to develop cirrhosis. Here, cost-effectiveness of antiviral therapy was assessed. A Markov model was developed to simulate disease progression and calculate outcome and costs of treatment. In the baseline analysis, Peg-IFN/RBV treatment prevented organ loss/death, gained quality-adjusted life-years (QALYs) and undercut the limit of cost-effectiveness of €50 000/QALY with an incremental cost-effectiveness ratio of approximately €40 400/QALY and €21 000/QALY for HCV genotype 1 and 2/3 patients, respectively. Furthermore, sensitivity analysis testing modified model parameters according to extreme data described in the literature confirmed cost-effectiveness for a lower or higher rate of fibrosis progression, increased non-HCV-related mortality, lower limits of utilities, a time horizon of 30 years, and additional costs in the year of death. On the other hand, cost-effectiveness was lost for patients with genotype 1 in case of doubled antiviral or life-time costs or an increased discount rate of 7%. New treatment strategies for HCV genotype 1 infected patients remained on the same level cost-effective, if additional costs did not exceed €10 774 per 10% sustained virologic response gain. We conclude that Peg-IFN/RBV treatment is cost-effective post transplant. This may support treatment decision in individual cases.
KW - Antiviral Agents
KW - Cost-Benefit Analysis
KW - Decision Support Techniques
KW - Genotype
KW - Hepacivirus
KW - Hepatitis C, Chronic
KW - Humans
KW - Interferon-alpha
KW - Liver Transplantation
KW - Quality-Adjusted Life Years
KW - Recurrence
KW - Ribavirin
KW - Treatment Outcome
U2 - 10.1111/tri.12085
DO - 10.1111/tri.12085
M3 - SCORING: Journal article
C2 - 23517333
VL - 26
SP - 527
EP - 534
JO - TRANSPL INT
JF - TRANSPL INT
SN - 0934-0874
IS - 5
ER -