Evidence map›Paper›PMID 32113623›Full record

ArticleValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research2020

Cost-Effectiveness Analysis of Baseline Testing for Resistance-Associated Polymorphisms to Optimize Treatment Outcome in Genotype 1 Noncirrhotic Treatment-Naïve Patients With Chronic Hepatitis C Virus.

Christopher G Fawsitt, Peter Vickerman, Graham S Cooke, STOP HCV Consortium, Nicky J Welton

Abstract read
In one paragraph

Article in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Christopher G FawsittDepartment of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK. Electronic address: c.fawsitt@bristol.ac.uk.
Peter VickermanDepartment of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK.
Graham S CookeDepartment of Medicine, Imperial College London, London, England, UK.
STOP HCV Consortium
Nicky J WeltonDepartment of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK.

Funding

Medical Research Council G0802413Medical Research Council MC_UU_12014/1Medical Research Council MR/K01532X/1Wellcome Trust 109965/Z/15/Z
6 · The paper itself

Abstract

objectivesDirect-acting antivirals containing nonstructural protein 5A (NS5A) inhibitors administered over 8 to 12 weeks are effective in ∼95% of patients with hepatitis C virus. Nevertheless, patients resistant to NS5A inhibitors have lower cure rates over 8 weeks (<85%); for these patients, 12 weeks of treatment produces cure rates greater than 95%. We evaluated the lifetime cost-effectiveness of testing for NS5A resistance at baseline and optimizing treatment duration accordingly in genotype 1 noncirrhotic treatment-naïve patients from the perspective of the UK National Health Service.

methodsA decision-analytic model compared (1) standard 12-week treatment (no testing), (2) shortened 8-week treatment (no testing), and (3) baseline testing with 12-/8-week treatment for those with/without NS5A polymorphisms. Patients who failed first-line therapy were retreated for 12 weeks. Model inputs were derived from published studies. Costs, quality-adjusted life-years, and the probability of cost-effectiveness were calculated.

resultsBaseline testing had an incremental net monetary benefit (INMB) of £11 838 versus standard 12 weeks of therapy (no testing) and low probability (31%) of being the most cost-effective, assuming £30 000 willingness to pay. Shortened 8 weeks of treatment (no testing) had an INMB of £12 294 and the highest probability (69%) of being most cost-effective. Scenario analyses showed baseline testing generally had the highest INMB and probability of being most cost-effective if first- and second-line drug prices were low (<£20k).

conclusionsOptimizing treatment duration based on NS5A polymorphisms for genotype 1 noncirrhotic treatment-naive patients in the United Kingdom is not cost-effective if the drug costs are high; the strategy is generally most cost-effective when drug prices are low (<£20k).

Indexed as

Drug CostsDrug Resistance, ViralPolymorphism, GeneticAdultAntiviral AgentsCost-Benefit AnalysisDecision Support TechniquesDecision TreesFemaleGenotypeHepacivirusHepatitis C, ChronicHumansMaleMarkov ChainsModels, EconomicAntiviral AgentsNS-5 protein, hepatitis C virusRNA-Dependent RNA PolymeraseViral Nonstructural Proteinsbaseline testingcost-effectivenesshepatitis C virusresistance-associated polymorphisms

Identifiers

PMID32113623
PMCPMC7057278

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.