SNFGE SNFGE
 
Thématique :
- Foie
- Hépatites virales
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Gut
  2015/08  
 
  2015 Aug;64(8):1277-88  
  doi: 10.1136/gutjnl-2014-307772  
 
  Cost-effectiveness analysis of sofosbuvir-based regimens for chronic hepatitis C  
 
  San Miguel R, Gimeno-Ballester V, Blázquez A, Mar J  
  http://www.ncbi.nlm.nih.gov/pubmed/25311032  
 
 

Background
A new scenario of therapy for chronic hepatitis C (CHC) is being established with the approval of sofosbuvir (SOF).

Objective
To estimate the cost-effectiveness of SOF-based regimens approved in the Summary of Product Characteristics (SmPC) versus the standard of care for different genotypes and patient populations (naive or pretreated).

Methods
A Markov model simulating CHC progression was used to estimate disease treatment costs and effects over patients’ lifetimes, from the Spanish National Public Healthcare System perspective. Different therapeutic options were analysed for genotypes 1, 2 and 3 in naive population and for genotype 2 and 3 pretreated patients, according to data obtained from clinical trials. A one-way sensitivity analysis was performed to evaluate the uncertainty of certain parameters: treatment starting age, transition probabilities, drug costs and discount rate. A probabilistic sensitivity analysis was also carried out.

Results
For the naive population, the option SOF+pegylated-interferon-α (pIFN)+ribavirin (RBV) for 12 weeks recorded in SmPC for genotype 1 and 3 versus pIFN+RBV for 24 weeks estimated an incremental cost-effectiveness ratio (ICER) below the €40 000/quality-adjusted life-year (QALY) benchmark. For the pretreated population, SOF triple therapy reached an ICER on the threshold limit for genotype 3. Other options included in SmPC for different genotypes exceeded the accepted efficiency limit in our setting.

Conclusions
The options that included SOF+RBV+pIFN in a 12-week course regimen fell below the efficiency threshold considered in our setting. IFN-free regimens administered for 24 weeks reached figures over the benchmark of €40 000/QALY.

 
Question posée
 
Est-ce que l’introduction du Sofosbuvir dans les traitement des hépatites chroniques C de génotype 1 à 3 est coût-efficace ?
 
Question posée
 
Cette étude a utilisé un modèle de Markov développé à partir du système de santé espagnol et conclut que les options : Sofosbuvir + IFN peg + ribavirine sont en dessous du seuil d’efficacité.
 
Commentaires

En France, étant donné les possibilités de traitement sans INF peg avec des associations sofosbuvir et d’autres anti-viraux directs, les résultats de cette étude ont peu d’intérêt.

 
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