Top 10 Practice-Changing Articles of 2012: Gastroenterology

David A. Johnson, MD


January 16, 2013

In This Article

Cost-Effectiveness of Boceprevir or Telaprevir for Untreated Patients With Genotype 1 Chronic Hepatitis C

Cammà C, Petta S, Enea M, et al
Hepatology. 2012;56:850-860


Adding Protease Inhibitors

Triple-therapy regimens (those combining peginterferon-alfa, ribavirin, and boceprevir or telaprevir) have significantly improved rates of sustained virologic response in patients with HCV infection. However, these improvements have been accompanied by new concerns about adverse effects and drug interactions associated with the first-generation protease inhibitors. Cost is another issue -- whether triple therapy is more cost effective than dual therapy is unknown. To this end, a group of European investigators created a Markov decision model with a 20-year horizon to analyze data from untreated patients with genotype 1 HCV infection and stage-2 liver fibrosis to assess the cost-effectiveness of 5 treatment strategies for HCV infection:

  • Boceprevir response-guided therapy (RGT)

  • Boceprevir interleukin 28B (IL28B) genotype-guided therapy

  • Boceprevir rapid virologic response-guided therapy (RVRT)

  • Telaprevir RGT

  • Telaprevir IL28B

Dual therapy was used for the IL28B treatment strategies if the IL28B CC genotype was identified and for the boceprevir RVRT strategy if rapid viral response was achieved during boceprevir lead-in. Outcomes included costs, years of life gained, and incremental cost-effectiveness ratio. The telaprevir IL28B and boceprevir RVRT strategies were the most clinically effective, with survival improvements of 4.42 years and 4.04 years, respectively, and were also the most cost-effective.


These results provide convincing evidence that triple therapy is cost-effective for chronic HCV infection, especially strategies involving RVRT and IL28B.