PROTEASE INHIBITOR NARLAPREVIR IN THERAPY OF HEPATITIS C VIRUS GENOTYPE 1 INFECTION IN TREATMENT-NAÏVE PATIENTS WITHOUT CIRRHOSIS: PHARMACOECONOMIC EVALUATION

The incidence of chronic hepatitis C inRussiais extremely high, that requires an increase the access to effective treatment regimens.

The aim of the study is to assess the cost of HCV therapy (genotype 1) of naïve patients without cirrhosis with second wave protease inhibitors narlaprevir and simeprevir in combination with peg-INF + RBV.

Materials and methods. Analysis of the cost-effectiveness is conducted from the perspective of the health care system. The assessment took into account only the cost of antiviral drugs. In the base case, costs were calculated based on the median price including VAT and the weighted average trade margin of theRussian Federationon given population. The cost of narlaprevir was calculated on the basis of estimated registration price including VAT and average trade margin on given population (price of registration – 98 000 RUB per pack 100 mg № 56). The sensitivity analysis evaluated the option of modifying the registered price of simeprevir and the estimated rates of narlaprevir registered price on 25%, and took into consideration the auction prices in 2016.

Results. In the base case costs on narlaprevir therapy 29,9% less compared with simeprevir (due to therapy with simeprevir failure after 4 weeks if lack of response). In the calculation of the full course of therapy, the savings increases to 38,4%. Analysis on prices of auctions also demonstrates the economic benefits of narlaprevir: estimated savings will account for 26,7% and 35,7% with and without allowance for failures with simeprevir in the absence of response after 4 weeks, respectively. Subgroup analysis shows that with any degree of fibrosis, narlaprevir allows reducing costs compared to simeprevir. Even in case of increasing the narlaprevir registration price and lower the simeprevir registration price compared to the baseline (in both cases – 25%) cost of therapy with narlaprevir will be 1,8% lower compared with simeprevir. Thus, the sensitivity analysis demonstrated a high reliability of the obtained results in the baseline.

Conclusions. Narlaprevir in combination with peg-INF + RBV will significantly decrease the cost of treatment of naïve patients with HCV genotype 1 infection without cirrhosis compared with the combination of simeprevir and therefore increase the availability of therapy. 

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