Coste-efectividad y seguridad de telaprevir y boceprevir para el tratamiento de la hepatitis C crónica en la práctica clínica

ResumenIntroducciónLa triple terapia con telaprevir o boceprevir ha resultado efectiva en el tratamiento de la hepatitis C crónica, con porcentajes de respuesta de hasta el 88%. Se asocia a importantes efectos adversos y supone un alto impacto económico.ObjetivoValorar el coste-efectividad y la seguridad de telaprevir y boceprevir.MétodosEstudio observacional retrospectivo. Se incluyó a pacientes que iniciaron tratamiento con inhibidores de proteasa antes del 31 de julio del 2013. Se valoraron la respuesta virológica sostenida, el coste por paciente curado y el coste de las medidas para el manejo de los efectos adversos.ResultadosSe incluyó a 59 pacientes, 35 con telaprevir (59,3%) y 24 con boceprevir (40,7%). Obtuvieron respuesta virológica sostenida 38 (64,4%) pacientes, 24 (68,6%) con telaprevir y 14 (58,3%) con boceprevir. El coste por paciente curado fue 43.555 € (IC del 95%, 35.389-51.722 €), sin diferencias significativas entre telaprevir, 43.494 € (IC del 95%, 34.795 €-55.092 €), y boceprevir, 42.005 € (IC del 95%, 32.122-64.243 €). El coste medio por paciente del manejo de los efectos adversos supuso 1.500 €, con un máximo 11.374 €. Para el tratamiento de los efectos adversos requirieron ingreso hospitalario 8 (13,6%) pacientes, visitas a Urgencias 22 (37,3%) pacientes y visitas médicas adicionales 26 (44,1%) pacientes.ConclusionesEl tratamiento con triple terapia basada en telaprevir o boceprevir ha supuesto un alto coste por paciente curado. Los efectos adversos desarrollados han requerido que un alto número de pacientes necesiten medidas de soporte, cuyo coste hay que añadir al del tratamiento con triple terapia.

IntroductionTriple therapy with telaprevir or boceprevir has proven to be effective in the treatment of chronic hepatitis C with response rates of up to 88%. However, the treatment may be associated with important adverse effects and a high economic impact.ObjectiveTo assess the cost-effectiveness and safety of triple therapy with telaprevir or boceprevir for the treatment of chronic hepatitis C.MethodsRetrospective observational study. We included all patients who had started treatment with protease inhibitors before July 31st, 2013. We evaluated sustained virological response, the cost per patient achieving sustained virological response, and the cost of the supportive treatment for adverse events associated with triple therapy.ResultsFifty-nine patients were included; 35 had been treated with telaprevir (59.3%) and 24 with boceprevir (40.7%). Sustained virological response was achieved by 38 (64.4%) patients: 24 (68.6%) patients in the telaprevir treatment arm and 14 (58.3%) patients in the boceprevir treatment arm. The cost per patient with sustained virological response was 43,555 € (95% CI 35,389-51,722 €). There were no statistically significant differences between the overall costs of therapy with telaprevir, 43,494 € (95% CI 34,795 €-55,092 €) versus boceprevir, 42,005 € (95% CI 32,122-64,243€). The mean cost of supportive care per patient was 1,500 €, while the maximum cost was 11,374 €. Due to adverse events, 8 (13.6%) patients required hospital admission, 22 (37.3%) patients attended the accident and emergency department, and 26 (44.1%) patients needed additional medical consultations.ConclusionsThe treatment of triple therapy with telaprevir or boceprevir resulted in high cost per patient with sustained virological response. Due to adverse events, a high number of patients required supportive care, whose costs should be added to those of triple therapy.