Abstract: FR-PO532

Real-World Cost-Effectiveness of Elbasvir/Grazoprevir (EBR/GZR) for the Treatment of Chronic Hepatitis C (CHC) in Treatment-Naïve (TN) Genotype (GT) 1 Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular


  • Nwankwo, Chizoba, Merck & Co, Lebanon, New Jersey, United States
  • Bacon, Bruce R., Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Corman, Shelby L, Pharmerit International, Bethesda, Maryland, United States
  • Curry, Michael P., Beth Israel Deaconess Medical Center, Boston, Alabama, United States
  • Flamm, Steven, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
  • Jiang, Yiling, Merck Sharp & Dohme Ltd., Hoddesdon, United Kingdom
  • Kowdley, Kris V, Swedish Medical Center, Seattle, Washington, United States
  • Milligan, Scott, Trio Health Analytics, La Jolla, California, United States
  • Tsai, Naoky, University of Hawaii, Kailua, Hawaii, United States

EBR/GZR, a once-daily fixed-dose combination direct-acting antiviral (DAA) was shown in the C-SURFER trial to be safe and effective for the treatment of CHC patients with CKD. The objective of this analysis was to evaluate real-world cost-effectiveness of EBR/GZR compared to no treatment using data from the TRIO Network.


A state-transition model of CHC, liver disease, and CKD was developed using Microsoft Excel. The model consists of 10 health states reflecting degree of liver fibrosis (F0-4), decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver transplant (LT); and 8 health states reflecting degree of CKD (Stages 1-5), hemodialysis, and kidney transplant. Baseline patient characteristics and the proportion of TN GT1 patients achieving sustained virologic response (SVR) were collected from a real-world study of 124 TN GT1 patients with CKD who were treated with EBR/GZR between January and October 2016, using data from the TRIO Network. Data on the rate of progression of hepatic and renal disease, annual costs for each health state, utilities, and risk of cardiovascular events were obtained from published literature. The primary outcome was the incremental cost-utility ratio (ICUR); secondary outcomes included the lifetime incidence of DC, HCC, LT, ESLD mortality, and life expectancy.


TN GT1 patients who received EBR/GZR were less likely to develop DC or HCC, receive a liver transplant, or die of liver-related causes compared to untreated patients, with a 2.4-year increase in life expectancy. Discounted costs and QALYs were both greater in patients receiving EBR/GZR compared to no treatment, with an ICUR of $53,897 QALY.


The model projected that EBR/GZR significantly reduces the incidence of liver disease complications compared to no treatment, using real-world patient characteristics and treatment outcomes. In addition, EBR/GZR was cost-effective for the treatment of CHC in patients with CKD.


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