Cost effectiveness of interferon or peginterferon with ribavirin for histologically mild chronic hepatitis C

London School of Hygiene and Tropical Medicine, Londinium, England, United Kingdom
Gut (Impact Factor: 14.66). 10/2006; 55(9):1332-8. DOI: 10.1136/gut.2005.064774
Source: PubMed


For patients with mild chronic hepatitis C the cost effectiveness of antiviral therapy is unknown.
To assess whether antiviral therapy (either interferon alpha or peginterferon alpha combined with ribavirin) is cost effective at a mild stage compared with waiting and only treating those cases who progress to moderate disease.
Cases with mild chronic hepatitis C.
A cost effectiveness model which estimates long term costs and outcomes for patients with mild chronic hepatitis C. The model uses effectiveness and cost data from the UK mild hepatitis C randomised controlled trial, combined with estimates of disease progression and cost from observational studies.
Antiviral treatment at a mild rather than a moderate stage improved outcomes measured by quality adjusted life years (QALYS) gained. The mean cost per QALY gained from antiviral treatment with interferon alpha-2b and ribavirin, compared with no treatment at a mild stage, was 4535 pounds sterling (7108 dollars) for patients with genotype non-1 and 25,188 pounds sterling (39,480 dollars) for patients with genotype 1. Providing peginterferon alpha-2b and ribavirin at a mild rather than a moderate stage was also associated with a gain in QALYS; the costs per QALY gained were 7821 pounds sterling (12,259 dollars) for patients with genotype non-1 and 28,409 pounds sterling (44,528 dollars) for patients with genotype 1.
For patients with chronic hepatitis C, it is generally more cost effective to provide antiviral treatment at a mild rather than a moderate disease stage. For older patients (aged 65 years or over) with genotype 1, antiviral treatment at a mild stage is not cost effective.

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Available from: Margaret Bassendine, Dec 17, 2013
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    • "Rather than basing cost-effectiveness on RCTs which tend to include atypical patients and centres, the study assessed cost-effectiveness in the 'real world' setting of routine clinical practice. The study design therefore extended the earlier CEA of antiviral treatment for mild chronic HCV (Grieve et al., 2006), whose scope was explicitly restricted to populations represented by those patients included in RCTs, and thus excluded both current and former IDUs. Grishchenko et al. (2009) were not explicit about excluding current IDUs from the scope, which was a major exclusion in view of HCV reinfection risk. "
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    • "Chronic HCV infections are endemic in Egypt, and based on the results of Ray et al., approximately 91% of Egyptian patients with chronic HCV, are infected with HCV genotype 4 (3). The first line of treatment for chronic hepatitis C is based on the use of one of the two pegylated interferon-alpha formulations, administered subcutaneously weekly, in combination with daily oral ribavirin (4, 5, 6). Adverse side effects of interferon include; a flu-like syndrome, myelosuppression, gastrointestinal problems (anorexia, nausea, vomiting, diarrhea, and transaminase elevation), neurological (somnolence and confusion) and dermatological toxicity. "
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