Reviewer's report
Title:Cost-Effectiveness of Sofosbuvir-Based Treatments for Chronic Hepatitis C
Version:2Date:6 February 2015
Reviewer: Thomas von Hahn
Reviewer's report:
This is a solid, relevant and timely piece of work. However, I do have a few
recommendation how this paper may be modified to be even more relevant given
the clinical reality of early 2015.
Major points:
- The model seems to miss the possibility of transitioning from HCC to liver
transplantation. However, in reality this does happen in a significant number of
cases. This should be included in the model or at least discussed.
- The meaning of and concept of ICER should be explained in a way that makes
it understandable for readers including those with a clinical background.
- It should be discussed whether SOF-based treatment is deemed superior to „no
treatment“ in any patient where interferon containing therapy is not an option
because of contraindications or because interferon based therapy has failed.
- Mention should be made of additional treatment option that have become
available since the introduction of sofosbuvir. It should at least be discussed how
– based on this modelt hat only includes sofosbuvir and no newer DAA’s – even
more potent DAA regimens will likely change the rcommendations made. This
seems relevant givem that at least in settings where DAA are widely available
stratedies of „IFN/ribavirin first, IFN-free second“ are rarely employed in practice.
Minor points:
- In the introduction referring to PEG/ribavirin therapy the authors state that „The
combination treatments achieve a 50–80% sustained virologic response (SVR)“.
This should be specified more precisely for genotype 1 vs 2/3. Throughout the
manuscript, whenever stating SVR rates it should be made clear what genotype
the percentage pertains to.
- When describing the studies the SVR rates for sofosbuvir containing treatments
are derived from patient numbers by genotype should be stated.
- The sentence on page 9, lines 4/5 should be changed to „As a benchmark, a
‚no treatment’ strategy results in an average life cost of $75,688 and 13.28
QALYs“
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
Thomas von Hahn is member of the speaker’s bureau of Bristol-Myers Squibb.
Reviewer's report
Title:Cost-Effectiveness of Sofosbuvir-Based Treatments for Chronic Hepatitis C
Version:2Date:6 February 2015
Reviewer: Thomas von Hahn
Reviewer's report:
This is a solid, relevant and timely piece of work. However, I do have a few
recommendation how this paper may be modified to be even more relevant given
the clinical reality of early 2015.
Major points:
- The model seems to miss the possibility of transitioning from HCC to liver
transplantation. However, in reality this does happen in a significant number of
cases. This should be included in the model or at least discussed.
- The meaning of and concept of ICER should be explained in a way that makes
it understandable for readers including those with a clinical background.
- It should be discussed whether SOF-based treatment is deemed superior to „no
treatment“ in any patient where interferon containing therapy is not an option
because of contraindications or because interferon based therapy has failed.
- Mention should be made of additional treatment option that have become
available since the introduction of sofosbuvir. It should at least be discussed how
– based on this modelt hat only includes sofosbuvir and no newer DAA’s – even
more potent DAA regimens will likely change the rcommendations made. This
seems relevant givem that at least in settings where DAA are widely available
stratedies of „IFN/ribavirin first, IFN-free second“ are rarely employed in practice.
Minor points:
- In the introduction referring to PEG/ribavirin therapy the authors state that „The
combination treatments achieve a 50–80% sustained virologic response (SVR)“.
This should be specified more precisely for genotype 1 vs 2/3. Throughout the
manuscript, whenever stating SVR rates it should be made clear what genotype
the percentage pertains to.
- When describing the studies the SVR rates for sofosbuvir containing treatments
are derived from patient numbers by genotype should be stated.
- The sentence on page 9, lines 4/5 should be changed to „As a benchmark, a
‚no treatment’ strategy results in an average life cost of $75,688 and 13.28
QALYs“
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
Thomas von Hahn is member of the speaker’s bureau of Bristol-Myers Squibb.
Please review this paper.
user
Reviewer's report
Title:Cost-Effectiveness of Sofosbuvir-Based Treatments for Chronic Hepatitis C
Version:2Date:6 February 2015
Reviewer: Thomas von Hahn
Reviewer's report:
This is a solid, relevant and timely piece of work. However, I do have a few
recommendation how this paper may be modified to be even more relevant given
the clinical reality of early 2015.
Major points:
- The model seems to miss the possibility of transitioning from HCC to liver
transplantation. However, in reality this does happen in a significant number of
cases. This should be included in the model or at least discussed.
- The meaning of and concept of ICER should be explained in a way that makes
it understandable for readers including those with a clinical background.
- It should be discussed whether SOF-based treatment is deemed superior to „no
treatment“ in any patient where interferon containing therapy is not an option
because of contraindications or because interferon based therapy has failed.
- Mention should be made of additional treatment option that have become
available since the introduction of sofosbuvir. It should at least be discussed how
– based on this modelt hat only includes sofosbuvir and no newer DAA’s – even
more potent DAA regimens will likely change the rcommendations made. This
seems relevant givem that at least in settings where DAA are widely available
stratedies of „IFN/ribavirin first, IFN-free second“ are rarely employed in practice.
Minor points:
- In the introduction referring to PEG/ribavirin therapy the authors state that „The
combination treatments achieve a 50–80% sustained virologic response (SVR)“.
This should be specified more precisely for genotype 1 vs 2/3. Throughout the
manuscript, whenever stating SVR rates it should be made clear what genotype
the percentage pertains to.
- When describing the studies the SVR rates for sofosbuvir containing treatments
are derived from patient numbers by genotype should be stated.
- The sentence on page 9, lines 4/5 should be changed to „As a benchmark, a
‚no treatment’ strategy results in an average life cost of $75,688 and 13.28
QALYs“
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
Thomas von Hahn is member of the speaker’s bureau of Bristol-Myers Squibb.
assistant