1. Comment on the paper 'Cost-effectiveness of sofosbuvir in hepatitis C genotype 1 infection in Germany: A reanalysis of published results'
- Author
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Andrew Sadler and Axel C. Mühlbacher
- Subjects
Chronic Hepatitis ,European People ,Gastroenterology and hepatology ,Economics ,Social Sciences ,Hepacivirus ,Geographical locations ,Chronic Liver Disease ,0302 clinical medicine ,Electronics Engineering ,Technology Assessment ,Germany ,Health care ,Ethnicities ,Medicine ,Public and Occupational Health ,Comparators ,Infectious diseases ,Engineering and Technology ,Drug Therapy, Combination ,Quality-Adjusted Life Years ,0305 other medical science ,medicine.medical_specialty ,Genotype ,Science Policy ,Science ,Immunology ,Antiviral Agents ,Microbiology ,Formal Comment ,03 medical and health sciences ,Health Economics ,Humans ,Liver diseases ,Pharmacology ,Health economics ,Flaviviruses ,Organisms ,Biology and Life Sciences ,medicine.disease ,Health Care ,Labor Economics ,Population Groupings ,Preventive Medicine ,Electronics ,RNA viruses ,Science and Technology Workforce ,Sofosbuvir ,Cost effectiveness ,Systems Engineering ,Cost-Benefit Analysis ,German People ,Publication Ethics ,medicine.disease_cause ,Careers in Research ,Hepatitis ,Medicine and Health Sciences ,030212 general & internal medicine ,Research Integrity ,Pathology and laboratory medicine ,Protease Inhibitor Therapy ,Multidisciplinary ,Careers ,Hepatitis C virus ,030503 health policy & services ,Cost-effectiveness analysis ,Hepatitis C ,Research Assessment ,Medical microbiology ,Vaccination and Immunization ,Drug Prices ,Europe ,Pharmacoeconomics ,Infectious hepatitis ,Viruses ,Pathogens ,Research Article ,medicine.drug ,Medical conditions ,Employment ,Cost-Effectiveness Analysis ,Antiretroviral Therapy ,Viral diseases ,Research and Analysis Methods ,Antiviral Therapy ,Internal medicine ,Ribavirin ,European Union ,business.industry ,Viral pathogens ,Interferon-alpha ,Publication bias ,Hepatitis C, Chronic ,Economic Analysis ,Hepatitis viruses ,Microbial pathogens ,Family medicine ,People and Places ,business - Abstract
ObjectivesRecently, the results of two economic evaluations were published both of which seemingly demonstrate the cost-effectiveness of sofosbuvir-based regimens for the treatment of chronic hepatitis C genotype 1 infection in Germany. Both analyses were sponsored by the manufacturer of sofosbuvir and use a different methodology: Whereas one evaluation is based on a conventional cost-utility analysis, the other rests upon the efficiency-frontier method used by the German Institute for Quality and Efficiency in Health Care (IQWiG). The purpose of this study is to reanalysis the results of both economic evaluations in combination.DesignReanalysis of published decision modelling results.SettingPrimary care in Germany.ParticipantsPatients with chronic hepatitis C genotype 1 infection (treatment-naïve and -experienced, cirrhotic and non-cirrhotic).InterventionsSofosbuvir, other anti-hepatitis C virus drugs, and no treatment.Primary and secondary outcome measuresCost per unit of health benefit and cost per quality-adjusted life year.ResultsReanalysis of the results of both economic evaluations in combination reveals an unclear rationale for choosing the selected cost-effectiveness methods as well as a potential publication bias, favoring the product of the manufacturer. Based on the reanalysis, sofosbuvir is not cost-effective in treatment-experienced non-cirrhotic patients, potentially lacks cost-effectiveness in treatment-experienced cirrhotic patients, and is only partially cost-effective in treatment-naïve non-cirrhotic patients. Taken together, these results indicate a lack of cost-effectiveness in three quarters of the German patient population.ConclusionsTwo economic evaluations on sofosbuvir suggest, in combination, that sofosbuvir cannot be considered a cost-effective treatment in three quarters of the German patient population.
- Published
- 2021