Present, old and future strategies for anti-HCV treatment in patients infected by genotype-1: estimation of the drug costs in the Calabria Region in the era of the directly acting antivirals

BMC Infectious Diseases

Research Article

Monica Basso¹  Saverio Giuseppe Parisi¹  Marzia Maria Franzetti¹  Alfredo Focಠ Giovanni Matera²  Emilia Zicca²  Maria Carla Liberto²  Nadia Marascio²  Giorgio Settimo Barreca²  Angelo Giuseppe Lamberti²  Sebastiano Di Salvo³  Francesca Giancotti³  Vincenzo De Maria³  Maria Concetta Postorino⁴  Alessio Strazzulla⁴  Chiara Costa⁴  Vincenzo Pisani⁴  Carlo Torti⁵ 

[1] Department of Molecular Medicine, University of Padua, Padua;Institute of Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Italy;Unit of Hepatology, Hospital "Mater Domini", Catanzaro, Italy;Unit of Infectious Diseases, University "Magna Graecia", Catanzaro, Italy;Unit of Infectious Diseases, University "Magna Graecia", Catanzaro, Italy;University Unit of Infectious Diseases, University of Brescia, School of Medicine, Brescia, Italy;

关键词: Cost;    SVR;    DAA;    HCV;    Telaprevir;   

DOI  :  10.1186/1471-2334-14-S5-S3

来源: Springer

【 摘 要 】

BackgroundIn Italy, anti-HCV drugs are provided free of charge by the National Health System. Since 2011, three drug regimens including a directly acting antiviral (DAA) are considered the gold standard for HCV treatment. However, these drugs add a significant cost (roughly €26,000) to the combination of pegylated-interferon-α/ribavirin (PEG-IFN/RBV), which before DAA represented the unique treatment. To provide the National Health System potential useful information, we estimated costs to provide anti-HCV drugs to treat a population experienced for PEG-INF/RBV.MethodsGenotype 1 HCV mono-infected or HIV/HCV co-infected individuals who were treated with PEG-IFN/RBV between 2008 and 2013 were included. The cost to treat these patients with PEG-IFN/RBV was calculated (cost 1). We also estimated costs if we had to treat these patients with a lead-in period of PEG-INF/RBV followed by PEG-IFN/RBV and a DAA in naïves (cost 2), in addition to cost 1 plus the estimated cost to re-treat with PEG-IFN/RBV and a DAA patients who had a relapse or a non response (cost 3). Moreover, all costs were normalized by SVR. Rates of foreseen response with DAA were obtained from literature data.ResultsThe overall study population consisted of 104 patients. The rate of sustained virological response (SVR) was 55%, while it was estimated that SVR would be obtained in 75% of patients with a lead-in period with PEG-IFN/RBV followed by a DAA combination, and in 78% if this treatment is used to re-treat experienced patients with a DAA. Drug costs associated with these treatments were: €1,214,283 for cost 1, €3,474,977 for cost 2 and €3,002,095 for cost 3. Costs per SVR achieved were: €22,284 for cost 1, €44,643 for cost 2 and €38,322 for cost 3.ConclusionsTreatments including DAAs achieve a SVR in more patients than PEG-IFN/RBV but they cost around three times more than PEG-IFN/RBV alone regimens. Also, cost per SVR is almost twofold greater than PEG-IFN/RBV regimens. Therefore, it is mandatory to implement use of DAA in clinical practice, but the National Health System should allocate adequate resources to provide drugs, which challenges sustainability. Cost reduction for anti-HCV drugs should be pursued.

【 授权许可】

Unknown   
© Strazzulla et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.