HEPATITIS

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

R Grieve¹, J Roberts¹, M Wright², M Sweeting³, D DeAngelis⁴, W Rosenberg⁵, M Bassendine⁶, J Main², H Thomas²

¹ Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
² Department of Medicine, Imperial College, London, UK
³ MRC Biostatistics Unit, Cambridge, UK
⁴ Statistics, Modelling and Bioinformatics Department, Health Protection Agency, London, UK, and MRC Biostatistics Unit, Cambridge, UK
⁵ Division of Infection Inflammation and Repair, University of Southampton, Southampton, UK
⁶ School of Clinical Medical Sciences, The Medical School, Newcastle upon Tyne, UK

Correspondence to:
Dr R Grieve
Health Services Research Unit, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK; richard.grieve{at}lshtm.ac.uk

Background: For patients with mild chronic hepatitis C the cost effectiveness of antiviral therapy is unknown.

Aims: To assess whether antiviral therapy (either interferon or peginterferon combined with ribavirin) is cost effective at a mild stage compared with waiting and only treating those cases who progress to moderate disease.

Patients: Cases with mild chronic hepatitis C.

Methods: 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.

Results: 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 -2b and ribavirin, compared with no treatment at a mild stage, was £4535 ($7108) for patients with genotype non-1 and £25 188 ($39 480) for patients with genotype 1. Providing peginterferon -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 ($12 259) for patients with genotype non-1 and £28 409 ($44 528) for patients with genotype 1.

Conclusions: 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.

Abbreviations: HCV, hepatitis C virus; SVR, sustained virological response; QALY, quality adjusted life year; HRQOL, health related quality of life; ICER, incremental cost effectiveness ratio; CEAC, cost effectiveness acceptability curve; HCC, hepatocellular carcinoma; RCT, randomised controlled trial

Keywords: cost effectiveness model; cost analysis; antiviral therapy

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