Effect of discounting on estimation of benefits determined by hepatitis C treatment.
The combination of either boceprevir or telaprevir with ribavirin and interferon (triple therapy) has been shown to be more effective than ribavirin+interferon (dual therapy) for the treatment of genotype 1 hepatitis C. Since the benefit of these treatments takes place after years, simulation models are needed to predict long-term outcomes. In simulation models, the choice of different values of yearly discount rates (e.g., 6%, 3.5%, 2%, 1.5% or 0%) influences the results, but no studies have specifically addressed this issue. We examined this point by determining the long-term benefits under different conditions on the basis of standard modelling and using quality-adjusted life years (QALYs) to quantify the benefits. In our base case scenario, we compared the long-term benefit between patients given a treatment with a 40% sustained virologic response (SVR) (dual therapy) and patients given a treatment with a 70% SVR (triple therapy), and we then examined how these specific yearly discount rates influenced the incremental benefit. The gain between a 70% SVR and a 40% SVR decreased from 0.45 QALYs with a 0% discount rate to 0.22 QALYs with a 6% discount rate (ratio between the two values = 2.04). Testing the other discounting assumptions confirmed that the discount rate has a marked impact on the magnitude of the model-estimated incremental benefit. In conclusion, the results of our analysis can be helpful to better interpret cost-effectiveness studies evaluating new treatment for hepatitis C.
['Messori|Andrea|A|', 'Fadda|Valeria|V|', 'Maratea|Dario|D|', 'Trippoli|Sabrina|S|']
D000998:Antiviral Agents D003198:Computer Simulation D003362:Cost-Benefit Analysis D004359:Drug Therapy, Combination D005838:Genotype D016174:Hepacivirus D019698:Hepatitis C, Chronic D006801:Humans D007372:Interferons D008390:Markov Chains D009842:Oligopeptides D011392:Proline D019057:Quality-Adjusted Life Years D012254:Ribavirin
Hepatitis C Boceprevir Telaprevir Cost-effectiveness Markov model