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Clinical Trial
. 2015 Dec;15(4):335-49.
doi: 10.1007/s40268-015-0109-5.

Determinant Factors of the Direct Medical Costs Associated with Genotype 1 Hepatitis C Infection in Treatment-Experienced Patients

Essè Ifèbi Hervé Akpo  1 , Urbano Sbarigia  2 , George Wan  3 , Joris Kleintjens  4
Affiliations
Clinical Trial

Determinant Factors of the Direct Medical Costs Associated with Genotype 1 Hepatitis C Infection in Treatment-Experienced Patients

Essè Ifèbi Hervé Akpo et al. Drugs R D. 2015 Dec.

Abstract

Objective: Limited evidence is available on predictors of medical resource utilization (MRU) and related direct costs, especially in treatment-experienced patients infected with genotype 1 hepatitis C virus (HCV). This study aimed at investigating patient and treatment characteristics that predict MRU and related non-drug costs in treatment-experienced patients with chronic hepatitis C (CHC) treated with simeprevir (SMV) or telapravir (TVR) in combination with pegylated interferon and ribavirin (PegIFN/R).

Patients and methods: A total of 709 patients who completed the 72-week ATTAIN trial were included in the study. Cost data were analysed from the UK NHS perspective. Descriptive statistics and regression analyses were used to determine patterns and predictors of total MRU-related costs associated with SMV/PegIFN/R and TVR/PegIFN/R.

Results: Independent predictors for total MRU-related costs were age, region and the following interaction terms: (1) gender × F3-F4 METAVIR score × baseline viral load (BLVL), (2) body mass index (BMI) × F3-F4 METAVIR score × prior response to PegIFN/R and (3) gender × achievement of SVR at 12 weeks (SVR12) × BLVL. A F3-F4 METAVIR score was a stronger predictor of total MRU-related costs than SVR12. Predictors of adverse events included older age, female gender, low BMI, TVR/PegIFN/R and SVR12. Wilcoxon rank sum test revealed comparable total MRU-related costs between SMV/PegIFN/R and TVR/PegIFN/R.

Conclusion: To the best of our knowledge, this study is the first to describe the relationship between commonly admitted predictors of MRU-related costs and their joint effect on total MRU-related costs in treatment-experienced patients with CHC. The identified predictors of MRU-related costs suggest that significant treatment costs can be avoided by starting treatment early before the disease progresses. Furthermore, adverse events seem to be the most important factor to take into consideration for the choice of treatment, especially when therapeutic options are associated with similar levels of medical resource utilization and associated costs.

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Figures

Fig. 1
Fig. 1
Histogram of total medical resource utilization (MRU)-related costs (£) for the prior non-responders to pegylated interferon and ribavirin (PegIFN/R) in the ATTAIN trial. The x axis represents the range of non-drug total MRU-related costs, calculated as follows: unit costs for each of the selected resources were multiplied by the number of visits made by each patient. Costs across the medical resources were then summed up for each of the patients. Costs were then grouped into ten bins and frequency calculated accordingly
Fig. 2
Fig. 2
Average baseline viral load in female and male patients with severe liver fibrosis and average BMI in prior non-responders to PegIFN/R with severe liver fibrosis. The graph on the left-hand side captures variables in the second-order gender × BLVL × F3–F4 interaction term. Average baseline viral load was plotted by gender levels for patients with severe liver fibrosis. The graph on the right-hand side captures variables in the F3–F4 × BMI × prior response to PegIFN/R interaction term. Average baseline BMI is segmented by levels of prior response to PegIFN/R in patients with severe liver fibrosis. BMI body mass index, BLVL baseline viral load, PegIFN/R pegylated interferon and ribavirin
Fig. 3
Fig. 3
Distribution of SVR12 achievers by therapy, gender and adverse events. Absence refers to patients that did not report any of the selected adverse events (i.e. anaemia, bilirubin, neutropenia, pruritus and rash). PegIFN/R pegylated interferon and ribavirin
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