PharmacoEconomics & Outcomes News 667 - 24 Nov 2012

In the third analysis, the cost per SVR was consistentlyTelaprevir vs boceprevir: no clearlower with telaprevir plus PR than boceprevir plus PRwinner regardless of previous treatment response or baselinedisease severity.5 For example, in treatment-naıveSeveral studies presented as posters at ISPORpatients, the cost per SVR was $Brz64 513* for telaprevircompared the cost effectiveness of telaprevir andplus PR compared with $Brz72 275 for boceprevir plusboceprevir in genotype 1 chronic hepatitis C virus (HCV)PR, and similar finding were reported in treatment-naıveinfection when used in combination with peginterferonpatients with METAVIR scores of F0–F3. For patientsalpha plus ribavirin (PR). In phase III trials, each of thesewith a partial response to previous therapy, costs peragents improved sustained virologic response (SVR)SVR were $Brz68 144 and $Brz90 658 for the respectiverates when combined with PR in HCV genotype 1, buttreatment groups.which triple regimen is more cost effective?* Brazilian realGreek and Dutch analyses favour telaprevir1. Yfantopoulos J, et al. A Cost-Effectiveness Analysis of Telaprevir VersusTelaprevir plus PR was less costly and more effective

Boceprevir in the Treatment of Hepatitis C: a Greek National Health Systemin terms of SVR rates than boceprevir plus PR in patients Perspective. 15th Annual European Conference of the International Society forPharmacoeconomics and Outcomes Research : abstr. PIN50, 3 Nov 2012.infected with HCV genotype 1, according to a decision

2. Vellopoulou K, et al. The Cost-Utility of Telaprevir in Combination withanalysis conducted from the healthcare payerPeginterfeon Alpha and Ribavirin (Pr) as Compared to the Combination

perspective in Greece.1 This finding was consistent in Boceprevir with Pr and to Pr Alone in the Management of Chronic Hepatitis Cin the Netherlands. 15th Annual European Conference of the Internationalthe overall hypothetical cohort and in theSociety for Pharmacoeconomics and Outcomes Research : abstr. PIN61, 3 Novsubpopulations of treatment-naıve and treatment- 2012.

experienced patients. 3. Fonseca M, et al. Cost Effectiveness of Boceprevir plus Peginterferon Alpha andRibavirin Versus Telaprevir plus Peginterferon Alfa and Ribavirin in theThese findings were echoed in the Netherlands,Treatment of Chronic Hepatitis C (Chc) in Previously Untreated Genotype Iwhere telaprevir plus PR dominated boceprevir plus PR Patients. 15th Annual European Conference of the International Society forPharmacoeconomics and Outcomes Research : abstr. PGI16, 3 Nov 2012.both in treatment-naıve and treatment-experienced

4. Fonseca M, et al. Cost Effectiveness of the Combination of Boceprevir pluspatients with HCV genotype 1.2 The study used aPeginterferon Alpha and Ribavirin Versus Telaprevir plus Peginterferon Alfa

Markov model with a lifetime horizon and was and Ribavirin in the Retreatment of Patients with Chronic Hepatitis C VirusGenotype I Infection. 15th Annual European Conference of the Internationalconducted from a societal perspective. The telaprevir-Society for Pharmacoeconomics and Outcomes Research : abstr. PGI21, 3 Novcontaining triple regimen was also dominant over PR in 2012.

treatment-experienced patients and had a favourable 5. Morais AD, et al. Cost Per Sustained Virological Response of Telaprevir andBoceprevir in the Treatment of Genotype 1 Hepatitis C Patients According toincremental cost-effectiveness ratio of €746 per QALYthe Previous Treatment Response and the Metavir Groups in Brazil. 15th Annualgained compared with PR in treatment-naıve patients. European Conference of the International Society for Pharmacoeconomics andOutcomes Research : abstr. PIN58, 3 Nov 2012.Both analyses incorporated clinical efficacy data from

801085638phase III trials with telaprevir (ADVANCE and REALIZE)and boceprevir (SPRINT-2 and RESPOND-2) and weresponsored by Janssen Cilag.

With mixed results in BrazilThree cost-effectiveness analyses in Brazil showed

mixed findings, with two studies favouring boceprevir(both sponsored by MSD)3, 4 and one backing telaprevir(sponsored by Janssen Cilag).5 All three modelsincorporated clinical efficacy data from some or all of theafore-mentioned phase III trials in patients infected withHCV genotype 1, depending on whether the analysisfocused on treatment-naıve or treatment-experiencedpatients or both.

Boceprevir plus PR dominated telaprevir plus PR intreatment-naıve patients3 and in treatment-experiencedpatients4, according to two analyses that used a similarMarkov model and were conducted by the sameresearchers. In both studies the reference patientinfected with HCV genotype 1 was 30 years of agewithout cirrhosis and a lifetime horizon was used. Theanalysis in treatment-naıve patients compared thefollowing regimens: (i) PR for 4 weeks followed byboceprevir for 24 weeks plus an additional 20 weeks ofPR for those who had a detectable HCV RNA level inweeks 8–24; and (ii) telaprevir for 12 weeks followed byPR for 12 weeks plus an additional 24 weeks of PR forthose who had a detectable HCV RNA level in weeks4–12. In treatment-experienced patients, the followingregimens were compared: (i) PR for 4 weeks followed byboceprevir for 32 weeks plus an additional 12 weeks ofPR for those who had a detectable HCV RNA level atweek 8; and (ii) telaprevir for 12 weeks followed by PRfor 36 weeks. Both studies found that boceprevir wasassociated with greater quality-adjusted life-expectancyand lower costs than telaprevir.

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PharmacoEconomics & Outcomes News 24 Nov 2012 No. 6671173-5503/10/0667-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved