Title: Cost-Effectiveness of Simeprevir Vs. Telaprevir for The Triple Therapy of Hepatitis C In Kazakhstan
Abstract: Hepatitis C Virus(HCV) is a growing health problem in the world. The aim of this study is to estimate a cost-effectiveness of a triple therapy(TT) with simeprevir compared to a TT with telaprevir for the previously treated with double therapy HCV patients in Kazakhstan. Markov model build in Tree-Age Pro 2013 was used for cost-effectiveness analysis from the perspective of Ministry of Health with a lifetime horizon. The model consists of two phases: (1)period of treatment with TT (48 weeks), and (2)lifetime follow-up. Cycle of the first phase is measured in weeks, the second - in years of life. The effectiveness was determined by the sustained virologic response(SVR), defined as HCV RNA<25 IU/mL after 12 weeks after completion of antiviral therapy. Effectiveness data was obtained from published RCTs, the direct costs adjusted to local settings are expressed in 2015 Kazakhstani Tenge(KZT). The average age of reference patient was 40 years. All future costs and health outcomes(QALYs) were discounted for 3% per year. One way sensitivity analysis was performed to test the robustness of model. Over 30-year stimulation of the model, TT with simeprevir incurred 6.81mln KZT and 24.2053 QALYs per patient, whereas TT with telaprevir incurred 10.98mln KZT and 24.2593 QALYs per patient. There was insignificant difference (p>0.05) in health outcomes between options. TT with simeprevir is expected to save 4.17mln KZT per patient if replases TT with telaprevir. The results of model were robust to changes in key parameters. The introduction of simeprevir as part of TT for HCV patients that had null or partial responce to previous double antiviral therapy seems to be a cost-effective option in Kazakhstan from the perspective of Ministry of Health compared to current TT with telaprevir. These findings may better inform decision makers regarding formulary inclusion and reimbursement.