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

Richard Grieve ^1*, Jennifer Roberts ¹, Mark Wright ², Mike Sweeting ³, Daniela DeAngelis ⁴, William Rosenberg ⁵, Margaret Bassendine ⁶, Janice Main ² and Howard Thomas ²

¹ LSHTM, United Kingdom
² Imperial College, United Kingdom
³ MRC Biostatistics Unit, United Kingdom
⁴ Health Protection Agency, United Kingdom
⁵ University Of Southampton, United Kingdom
⁶ Medical School, Newcastle upon-Tyne, United Kingdom

^* To whom correspondence should be addressed. E-mail: richard.grieve{at}lshtm.ac.uk.

Accepted 4 January 2006

Abstract

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

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

Patients: Cases with mild chronic hepatitis C.

Methods: A cost-effectiveness model 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 RCT, 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 & [alpha]2b and ribavirin, compared to no treatment at a mild stage, was £4,535 ($7,108) 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 £7,821 ($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 or over) with genotype 1, antiviral treatment at a mild stage is not cost-effective.

Keywords: antiviral therapy, cost analysis, cost-effectiveness model

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