Costs of telaprevir-based triple therapy for hepatitis C:... : Hepatology (original) (raw)

Viral Hepatitis

Costs of telaprevir-based triple therapy for hepatitis C: $189,000 per sustained virological response

Bichoupan, Kian1; Martel-Laferriere, Valerie1; Sachs, David2; Ng, Michel1; Schonfeld, Emily A.1; Pappas, Alexis1; Crismale, James1; Stivala, Alicia1; Khaitova, Viktoriya1; Gardenier, Donald1; Linderman, Michael2; Perumalswami, Ponni V.1; Schiano, Thomas D.1; Odin, Joseph A.1; Liu, Lawrence1; Moskowitz, Alan J.3; Dieterich, Douglas T.1; Branch, Andrea D.1

From the 1 Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; 2Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY; 3Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.

Received 25 March 2014; revised 11 June 2014; accepted 24 July 2014

Published online 25 August 2014.

Address reprint requests to: Kian Bichoupan, M.S., Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029. E-mail:[email protected]; fax: 212–849–2574.

Potential conflict of interest: Dr. Schiano advises and received grants from Vertex, Novartis, Salix, Merck, Bristol-Myers Squibb, Janssen, iTherX, and Biotest. Mr. Bichoupan consults for Janssen and Gilead. Dr. Branch consults for Janssen and Gilead. Dr. Dieterich consults and received grants from Bristol-Myers Squibb, Boehringer Ingleheim, Gilead, Merck, and AbbVie. Dr. Ng consults, advises, and received grants from AbbVie.

This work was supported, in part, by grants from Gilead Sciences and the National Institutes of Health (DA031095 and DK090317). Valérie Martel-Laferrière was supported by a 2011 AMMI Canada/Pfizer postresidency fellowship and a 2012 grant of the CHUM Foundation.

Abstract

In registration trials, triple therapy with telaprevir (TVR), pegylated interferon (Peg-IFN), and ribavirin (RBV) achieved sustained virological response (SVR) rates between 64% and 75%, but the clinical effectiveness and economic burdens of this treatment in real-world practice remain to be determined. Records of 147 patients who initiated TVR-based triple therapy at the Mount Sinai Medical Center (May-December 2011) were reviewed. Direct medical costs for pretreatment, on-treatment, and posttreatment care were calculated using data from Medicare reimbursement databases, RED Book, and the Healthcare Cost and Utilization Project database. Costs are presented in 2012 U.S. dollars. SVR (undetectable hepatitis C virus [HCV] RNA 24 weeks after the end of treatment) was determined on an intention-to-treat basis. Cost per SVR was calculated by dividing the median cost by the SVR rate. Median age of the 147 patients was 56 years (interquartile range [IQR] = 51–61), 68% were male, 19% were black, 11% had human immunodeficiency virus/HCV coinfection, 36% had advanced fibrosis/cirrhosis (FIB-4 scores ≥3.25), and 44% achieved an SVR. The total cost of care was 11.56million.Mediancostofcarewas11.56 million. Median cost of care was 11.56million.Mediancostofcarewas83,721 per patient (IQR = 66,652−66,652-66,652−98,102). The median cost per SVR was 189,338(IQR=189,338 (IQR = 189,338(IQR=150,735-$221,860). Total costs were TVR (61%), IFN (24%), RBV (4%), adverse event management (8%), professional fees (2%), and laboratory tests (1%). Conclusions: TVR and Peg-IFN accounted for 85% of costs. Pharmaceutical prices and the low (44%) SVR rate, in this real-world study, were major contributors to the high cost per SVR. (Hepatology 2014;60:1187–1195)