17 Prior to treatment initiation, a percentage of the cohort may progress and become ineligible for treatment, or may die; this is dependent upon the timing of treatment initiation. Selleckchem STA-9090 We model the treatment of patients with genotype 1 using telapravir in combination with peginterferon-alfa plus ribavirin; genotypes 2 and 3 are treated with peginterferon-alfa plus ribavirin. Sustained virological response (SVR) rates among patients infected with genotype 1 HCV commencing treatment in fibrosis stages F0-F2 and F3-F4 were 0.78 and 0.62, respectively22; for genotype 2 and 3, SVR rates were 0.76, 0.61, and 0.57

in those treated in fibrosis stages F0-F2, F3, and F4, respectively.23 The MONARCH HCV model is designed to progress a cohort of subjects, in annual cycles, through the Metavir disease stages: F0 (no fibrosis) through F1 (portal fibrosis with no septa), F2 (portal fibrosis with few septa), F3 (portal fibrosis with numerous septa), and F4 (compensated cirrhosis) and potentially on to ESLD complications. The model flow diagram is shown in Fig. 2. Progression through fibrosis stages is controlled via stage-specific transition probabilities

influenced by duration of HCV infection, age, sex, genotype, source of infection (acting as a proxy for post-acquisition behavior), and excessive alcohol consumption (defined as an average daily consumption >20 g).24 Table 1 reports the transition rates and baseline parameters used in the

model. We assumed 75% of chronic HCV infections are genotype 1.17 Subjects enter the model immediately after testing Temsirolimus order and, in the base case, are distributed across fibrosis stages: (15.0% in F0; 29.5% in F1; 20.3% in F2; 17.1% in F3; 18.1% in F4).17 There are three cohort profiles propagated through the model: 1 Subjects undiagnosed. These subjects progress through the model potentially incurring costs for ESLD complications and health utility decrements associated with ESLD complications. We assumed no costs of chronic HCV were incurred by these individuals. The model assumes no difference in fibrosis stage progression rates between those diagnosed and not diagnosed. The model is run over a lifetime and 上海皓元 predicts total costs, QALYs, the number of predicted liver-related complications, and deaths per year. Although our base case analysis focuses on comparing a birth cohort testing and treatment strategy with a risk-based testing and treatment strategy, our primary focus was on the effect of stratifying treatment in those tested by age, fibrosis stage, and time. The model takes a health care payer perspective and considers only direct medical costs; these are presented in Table 2. HCV specific treatment and monitoring costs are derived from weekly estimated costs accommodating duration of treatment; we assume null responders are treated for 12 weeks only. Testing and healthcare costs were estimated from contemporary U.S sources.