Impact on Incremental Cost per QALY Gained of Starting Age, METAVIR Score, Sex, and Alternative Modeling Assumptions.

ICER indicates incremental cost-effectiveness ratio; PR, peginterferon alfa-2a plus ribavirin; QALY, quality-adjusted life-year; SVR, sustained virologic response; TVR, telaprevir.aThe base-case values and assumptions were as follows: patient population distribution by sex, age, and METAVIR fibrosis score from the ADVANCE and REALIZE clinical trials; lifetime time horizon; 3% annual discount rate; incremental difference in treatment-phase utility values for TVR+PR compared with PR alone of 0.01 for treatment-naïve patients and prior relapsers and –0.03 for prior partial responders and prior null responders; utility value of 0.87 for health states F0 to F4 if SVR was achieved; and clinical assumption that patients with advanced fibrosis (F3-F4) remained at risk for further liver deterioration even if SVR is achieved; probability of death after liver transplant of 0.210 in first year, 0.057 in years 2+.bTVR+PR dominates PR alone, with more QALYs at a lower total cost.cThe subgroup of male prior partial responders in the PR arm of REALIZE was very small (n = 15). The high ICER for this subgroup was the result of the SVR achieved by the 1 male with baseline fibrosis score F4. Caution should be exercised in interpreting this ICER.dBased on estimates reported in Thein et al., 2009 [42].