Excerpt

There is great potential to improve health outcomes for Veterans and other patients with chronic genotype 1 (GT1) Hepatitis C (HCV) infections through the use of newly-available triple combination therapies that include directly acting antivirals (DAA) along with recently developed patient genotyping (IL-28B) which is predictive of HCV treatment response. Chronic GT1 HCV infections have been historically difficult to treat, with low cure rates on standard two drug therapy (Pegylated Interferon + Ribavirin), high rates of side-effects and treatment discontinuation, and low rates of uptake. Recently, FDA approved two DAAs (boceprevir and telaprevir). Used in combination with standard two drug therapy as triple therapy, these DAAs show higher rates of sustained viral response, though they are also more costly and have more severe side-effect profiles. IL-28B genotyping can help to identify patients least likely to respond to standard therapy and hence who stand to benefit the most from triple therapy and for whom, therefore, the increased risks of side-effects may be most justified.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • PEER REVIEW
  • RESULTS
  • ABBREVIATIONS TABLE
• INTRODUCTION
• METHODS
  • ADAPTING PREVIOUSLY DEVELOPED HCV MODEL TO VA
  • PRELIMINARY ANALYSES OF VA ADMINISTRATIVE DATA
  • PEER REVIEW
• RESULTS
  • RESULTS USED TO INFORM THE MODEL
  • KEY QUESTION #1 What are the current usage patterns of directly acting antivirals and of IL-28B patient genotyping in the VA health system? And how do these patterns differ by VISN?
  • KEY QUESTION #2 What will be the health impacts of using either of two available directly acting antivirals combined with pegylated interferon and ribavirin (triple therapy)?
  • KEY QUESTION #3 How will the magnitudes of the health impacts measured in Key Question #2 change if IL-28B patient genotyping is used to offer triple therapy to those less likely to benefit from two-drug pegylated interferon + ribavirin?
  • KEY QUESTION #4 What will be the cost and resource use patterns when using either triple therapy or IL-28B-guided triple therapy?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A PEER REVIEW COMMENTS/AUTHOR RESPONSES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, Paul G. Shekelle, MD, PhD, Director. VA Health Economics Resource Center, Menlo Park, CA, Paul G. Barnett, PhD, Director

Suggested citation:

Goldhaber-Fiebert JD, Barnett PG, Dally S, Asch SM, Liu S, Cipriano L, Owens DK, Miake-Lye IM, Beroes JM, Shekelle PG. Assessment of Alternative Treatment Strategies for Chronic Genotype 1 Hepatitis C. VA ESP Project #05-226, 2013.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.