{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T13:12:21Z","timestamp":1775567541890,"version":"3.50.1"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:p>\n                    Recently approved, interferon\u2010free medication regimens for treating hepatitis C are highly effective, but extremely costly. We aimed to identify cost\u2010effective strategies for managing treatment\u2010na\u00efve U.S. veterans with new hepatitis C medication regimens. We developed a Markov model with 1\u2010year cycle length for a cohort of 60\u2010year\u2010old veterans with untreated genotype 1 hepatitis C seeking treatment in a typical year. We compared using sofosbuvir\/ledipasvir or ombitasvir\/ritonavir\/paritaprevir\/dasabuvir to treat: (1) any patient seeking treatment; (2) only patients with advanced fibrosis or cirrhosis; or (3) patients with advanced disease first and healthier patients 1 year later. The previous standard of care, sofosbuvir\/simeprevir or sofosbuvir\/pegylated interferon\/ribavirin, was included for comparison. Patients could develop progressive fibrosis, cirrhosis, or hepatocellular carcinoma, undergo transplantation, or die. Complications were less likely after sustained virological response. We calculated the incremental cost per quality\u2010adjusted life year (QALY) and varied model inputs in one\u2010way and probabilistic sensitivity analyses. We used the Veterans Health Administration perspective with a lifetime time horizon and 3% annual discounting. Treating any patient with ombitasvir\u2010based therapy was the preferred strategy ($35,560; 14.0 QALYs). All other strategies were dominated (greater costs\/QALY gained than more effective strategies). Varying treatment efficacy, price, and\/or duration changed the preferred strategy. In probabilistic sensitivity analysis, treating any patient with ombitasvir\u2010based therapy was cost\u2010effective in 70% of iterations at a $50,000\/QALY threshold and 65% of iterations at a $100,000\/QALY threshold.\n                    <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>\n                    : Managing any treatment\u2010na\u00efve genotype 1 hepatitis C patient with ombitasvir\u2010based therapy is the most economically efficient strategy, although price and efficacy can impact cost\u2010effectiveness. It is economically unfavorable to restrict treatment to patients with advanced disease or use a staged treatment strategy. (H\n                    <jats:sc>epatology<\/jats:sc>\n                    2016;63:428\u2013436)\n                  <\/jats:p>","DOI":"10.1002\/hep.28327","type":"journal-article","created":{"date-parts":[[2015,11,2]],"date-time":"2015-11-02T18:11:23Z","timestamp":1446487883000},"page":"428-436","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":29,"title":["Cost\u2010effectiveness of new antiviral regimens for treatment\u2010na\u00efve U.S. veterans with hepatitis C"],"prefix":"10.1097","volume":"63","author":[{"given":"Alexis P.","family":"Chidi","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine,University of Pittsburgh School of Medicine,Pittsburgh,PA"},{"name":"VA Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System,Pittsburgh,PA"},{"name":"Department of Surgery,University of Pittsburgh School of Medicine,Pittsburgh,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shari","family":"Rogal","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine,University of Pittsburgh School of Medicine,Pittsburgh,PA"},{"name":"VA Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System,Pittsburgh,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cindy L.","family":"Bryce","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine,University of Pittsburgh School of Medicine,Pittsburgh,PA"},{"name":"Department of Health Policy and Management,University of Pittsburgh Graduate School of Public Health,Pittsburgh,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Fine","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine,University of Pittsburgh School of Medicine,Pittsburgh,PA"},{"name":"VA Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System,Pittsburgh,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chester B.","family":"Good","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine,University of Pittsburgh School of Medicine,Pittsburgh,PA"},{"name":"VA Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System,Pittsburgh,PA"},{"name":"VA Center for Medication Safety, Department of Veterans Affairs,Hines,IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larissa","family":"Myaskovsky","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine,University of Pittsburgh School of Medicine,Pittsburgh,PA"},{"name":"VA Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System,Pittsburgh,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinod K.","family":"Rustgi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition,University of Pittsburgh School of Medicine,Pittsburgh,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Tsung","sequence":"additional","affiliation":[{"name":"Department of Surgery,University of Pittsburgh School of Medicine,Pittsburgh,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine,University of Pittsburgh School of Medicine,Pittsburgh,PA"},{"name":"VA Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System,Pittsburgh,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2015,12,21]]},"reference":[{"key":"hep28327-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1002\/hep.26141","article-title":"Global epidemiology of hepatitis C virus infection: new estimates of 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