HEALTH TECHNOLOGY ASSESSMENT FOR TREATMENT OF CHRONIC HEPATITIS C REIMBURSED BY PUBLIC HEALTH FUND IN BULGARIA, 2016
Journal Title: Българско списание за обществено здраве (Bulgarian Journal of Public Health) - Year 2016, Vol 0, Issue 3
Abstract
In this study there have been defined the direct costs of treatment of chronic hepatitis C (CHC) by protease inhibitors (Pi), NS5B inhibitors (NS5Bi), NS5A inhibitors (NS5Ai) and calculated the coefficient of efficiency of the additional costs (incremental cost-effectiveness ratio, ICER) per year, consistent with the quality of life (quality adjusted life year, QALY) in Bulgaria through transfer and adaptation of data from evaluations of Pi, NS5Bi, NS5Ai therapies to the local environment. The aim is to create pharmacotherapy guidance for treatment of CHC based on evidence, for comparative therapeutic efficacy and cost effectiveness of medicinal alternatives as the main approach to the management of public expenditure in Bulgaria. Material and methods. There has been made a systematic review of published data from analyses of the cost-effectiveness of Pi, NS5Bi, NS5Ai to treat CHC. Databases used are: MEDLINE, EMBASE, Web of Science, Cochrane Library. Literature search covers the period from January 2014 to July 2016. Data for health benefits in terms of additional QALY are directly transferred for the purposes of this analysis. Data on direct health care costs, associated with the treatment by Pi, NS5Bi, NS5Ai, are based on local reference prices in Bulgaria by August 2016. Results. The selection of published data on the costeffectiveness of Pi, NS5Bi, NS5Ai to treat CHC, identified 12 studies included in this analysis. The summarized analysis requires the following conclusions: 1. The use of combination drug therapies that do not involve Pegylated interferon (peginterferon, pegIFN), as SOF + LED and OMB + PAR + RIT ± DAS + R, is a cost non-effective approach compared with combination therapies containing peginterferon, in the treatment of patients with CHC (GT1,4 ± CIR. 2. In an indirect comparison of combination drug therapies presented in a pharmaceutical form (OMB/ PAR/RIT vs SOF/LED), used in combinations that do not include peginterferon, found that OMB/PAR/ RIT dominates SOF/LED with a better therapeutic outcomes and lower cost for treatment cycle (ΔQALY + 0,73; Δcosts - 7516 BGN). In conclusion, pharmacotherapy guidelines for the treatment of patients with CHC GT1,4 ± CIR in Bulgaria based on a comparative assessment of therapeutic efficacy, safety and pharmaco-economic indicators recommended as first therapeutic line the use of peginterferon, including combinations and only after failure as a second therapeutic line to use combination therapies as SOF/LED and OMB/PAR/RIT.
Authors and Affiliations
Tony Vekov, Petko Salchev
Keywords
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