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960A AASLD ABSTRACTS HEPATOLOGY, October, 2015 Disclosures: George K. Lau - Consulting: Roche, Novartis, Roche, Novartis, Roche, Novartis, Roche, Novartis The following authors have nothing to disclose: Fan Li, Guofeng Chen, Qing Shao, Dong Ji, Bing Li, Zhongbin Li, Jialiang Liu, Chunxiao Liu, Tingting Wang, Qiaomin Wang, Jing Chen, Vanessa Wu, April Wong, Cheng Wang, Yudong Wang 1538 The Value of Cure Associated with Treating Treatment-naïve (TN) Chronic Hepatitis C (CH-C) Genotype 1 (GT1): Are the New All Oral Regimens a Good Value to Society? Zobair M. Younossi 1,2 , Haesuk Park 3 , Douglas Dieterich 4 , Sammy Saab 5 , Aijaz Ahmed 6 , Stuart C. Gordon 7 ; 1 Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA; 2 Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA; 3 University of Florida, Gainesville, FL; 4 Icahn School of Medicine at Mount Sinai, New York City, NY; 5 University of California Los Angeles, Los Angeles, CA; 6 Stanford University, Standford, CA; 7 Henry Ford Hospital, Detroit, MI Background and Aim: The approval of all-oral regimens has led to substantially high cure rates. Our aim was to assess the value of cure to society by treating HCV GT1. Methods: A Markov model for HCV GT1 projected long-term health outcomes, life-years (LYs), and quality-adjusted life-years (QALYs) gained for a lifetime horizon. The model compared current therapies in the US [2nd generation triple (sofosbuvir+PR & simeprevir+PR) and all-oral therapy treatments (ledipasvir/sofosbuvir and ombitasvir+paritaprevir/ritonavir+dasabuvir±ribavirin] with no treatment option. Sustained virologic response (SVR) rates were based on Phase III clinical trials. We assumed that 80% and 95% of HCV GT1 patients are eligible for 2nd generation triple and all-oral regimens. Transition probabilities, utility and mortality were based on literature review and consensus by hepatologists. Results: In 2015, 1.11 million individuals were TN with HCV-GT1. The model estimated that treating all eligible HCV GT1 patients with 2nd generation triple and all-oral therapies can result in 1.8 million and 2.9 million additional QALYs gained. Using a threshold of $50,000 to $150,000 for the value of a QALY, these regimens led to savings of $91- $274 billion and $144-$432 billion. Also, the costs of these regimens were $80 billion and $93 billion. The value of cure was assessed by subtracting the costs of the regimens from the economic gains associated with the value of QALYs. The value of cure with 2nd generation triple and all oral regimens was estimated at $12-$194 billion and $51-$340 billion. Each HCV GT1 patient cured with 2nd generation triple and all oral regimens could save the U.S. between $10,381-$174,473 and $46,141-$305,021. Conclusions: The recent evolution of regimens for HCV GT1 has increased efficacy and value of cure. Curing all eligible HCV-GT1 patients with all-oral regimen leads to substantial savings to the U.S. society. Disclosures: Zobair M. Younossi - Advisory Committees or Review Panels: Salix, Janssen, Vertex; Consulting: Gilead, Enterome, Coneatus Haesuk Park - Consulting: Gilead Science Douglas Dieterich - Advisory Committees or Review Panels: Gilead, BMS, Abbvie, Janssen, Merck, Achillion Sammy Saab - Advisory Committees or Review Panels: BMS, Gilead, Merck, Janssen; Grant/Research Support: Gilead; Speaking and Teaching: BMS, Gilead, Merck, Janssen, Salix, Onyx, Bayer, Janssen; Stock Shareholder: Achillion, Johnson and Johnson, BMS, Gilead Aijaz Ahmed - Consulting: Bristol-Myers Squibb, Gilead Sciences Inc., Roche, AbbVie, Salix Pharmaceuticals, Janssen pharmaceuticals, Vertex Pharmaceuticals, Three Rivers Pharmaceuticals; Grant/Research Support: Gilead Sciences Inc. Stuart C. Gordon - Advisory Committees or Review Panels: Janssen; Consulting: Merck, Gilead, BMS, CVS Caremark, Amgen, AbbVie; Grant/Research Support: Merck, Gilead, AbbVie, Intercept Pharmaceuticals, Exalenz Sciences, Inc., BMS 1539 Rethinking pricing policy of direct antiviral agents to cure chronic hepatitis C infection at a population-level Francois Girardin, Nathalie Vernaz, Nicolas Goossens, Francesco Negro; Geneva University Hospital, Geneva, Switzerland Background Although cost-effectiveness of new direct antiviral agents for chronic hepatitis C viral infection (HCV) is a prerequisite for reimbursement, a population-level cure would induce staggering upfront costs. We investigated the correlation between sustained virological response (SVR) and drug costs. Methods We derived medication costs from Swiss public reimbursement prices and extracted published SVR data of currently available HCV therapies (ribavirin, pegylated interferon, simeprevir, boceprevir, telaprevir, sofosbuvir, ledipasvir, ombitasvir, paritaprevir, dasabuvir). We stratified cost-analysis by HCV genotype and presence/absence of cirrhosis (in treatment naïve patients). We measured the correlation between the costs and SVR. All cost results are reported in USD or CHF, as with the rounded exchange rate of 1 USD=1 Swiss franc might be considered (2015). Results For both patient groups, we found a correlation between SVR and cost, where R 2 was higher for naive cirrhotic patients (67.8%) compared to naive the non-cirrhotic patient group (56.4%) indicating that the more one spends on a treatment strategy, the higher the SVR. The costs extended between USD12,690 and USD133,750 per SVR (Fig.1). Discussion There is a significant correlation between the rate of SVR and the costs of treatment strategy. Payment per patient recovery, regardless of dose and treatment duration, including risk-sharing with drug manufacturers would allow better budget control and long-term projections. Alternatively, pricing volume per year would also minimize resources consumption and maximize health benefits and allow the manufacturer to provide large amount of drug before the era of DAA generics.
HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 961A (IQR 24-52 months) with negative HBV-DNA. HCC incidence was higher in cirrhotic patients (global – 15.6%; 3.8% per year) than in patients without cirrhosis (global 1%; 0.2% per year), p
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1312A AUTHOR INDEX HEPATOLOGY, Octo
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1366A CATEGORY INDEX HEPATOLOGY, Oc
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