Predicting the impact of adverse events and treatment duration on medical resource utilization-related costs in hepatitis C genotype 1 treatment-naïve patients receiving antiviral therapy

Abstract

Objectives: Studies on medical resource utilization (MRU) and related costs are important for evaluating the potential patient management and cost-effectiveness implications of antiviral treatments for hepatitis C virus (HCV) infection. The objectives of this study were (i) to compare the MRU and related costs for two treatment approaches; (ii) to identify the main drivers of resource use and costs; and (iii) to assess the effects of various treatment regimen attributes on MRU-related costs in a UK clinical setting.

Methods: The analysis used data collected alongside the simeprevir (SMV) phase III trials for treatment-naïve genotype 1 HCV-infected patients; these data covered outpatient consultations with specialists, emergency room visits and hospital admissions. Logistic regressions were constructed to estimate the predictors of resource utilization, and a two-part multivariable analysis model was used to determine the total costs of treatment in the UK.

Results: Data on 731 patients receiving SMV plus pegylated interferon and ribavirin (SMV/PegIFN/R) or PegIFN/R were included in the analysis. While MRU was similar between the SMV and PegIFN/R groups, MRU-related costs were significantly lower in the SMV group than in the PegIFN/R group (P < 0.05). High body mass index (P < 0.05), severe fibrosis (P < 0.05), shortened treatment duration to 24 weeks (P < 0.05), and anaemia and rash during treatment (P < 0.001) were identified as predictors of hospitalization and outpatient visits and as drivers of total costs. Univariate sensitivity analyses suggested that shortened treatment duration and lower occurrence of rash lead to large cost savings.

Conclusion: This study identified both baseline and on-treatment antiviral therapy characteristics as drivers of MRU-related costs for HCV patients following antiviral therapy. The shortened treatment duration and reduction in rash due to treatment with SMV triple therapy lead to substantial non-drug cost savings, compared with PegIFN/R treatment. This suggests that there are potential patient management and cost-effectiveness implications associated with the choice of specific antiviral treatments.

Fig. 1

Predicted medical resource utilization (MRU)-related costs [£] per cohort associated with simeprevir plus pegylated interferon and ribavirin (simeprevir/PegIFN/R) versus PegIFN/R. Notched box-plot summarizing the distribution of MRU-related costs based on the trial’s population characteristics. A cohort of 5,000 patients was simulated, and 1,000 Monte Carlo simulations were performed. The absence of overlap between the notches of simeprevir/PegIFN/R and PegIFN/R indicates that the medians are significantly different from each other. The median MRU-related costs per cohort in the simeprevir/PegIFN/R arm and the PegIFN/R arm were £1,461,512 and £2,124,041, respectively

Fig. 2

Univariate sensitivity analysis of simeprevir plus pegylated interferon and ribavirin (simeprevir/PegIFN/R) on the median medical resource utilization (MRU)-related cost savings per cohort. The tornado diagram shows the degree to which uncertainty in individual variables affects the median MRU-related cost savings. Univariate sensitivity analyses were conducted by changing by ±30 % the values of the reference case. The changes were applied only to the simeprevir/PegIFN/R arm, and for each change in the parameter value, 1,000 Monte Carlo iterations were performed. The simulated population size was about 5,000 patients. Savings were defined as the difference between the costs in the simeprevir/PegIFN/R arm and the PegIFN/R arm