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I read with great interest the excellent cost effectiveness analysis of pegylated interferon alpha 2b and ribavirin combination in patients with chronic hepatitis C (
). I was surprised by the relatively low cost of treatment initiation in Germany (table 3). The cost estimate of pre-therapeutic diagnostics, at 473, included a pregnancy test, quantitative hepatitis C virus-RNA, thyroid stimulating hormone, thyroxine, liver biopsy, and partial inpatient cost for initiation of treatment. Do you exclude the genotype assessment in these baseline tests? In a previous US cost effectiveness study1 and in our hospital, the same pre-therapeutic diagnostics seems more expensive (>1000). How do you estimate the cost of a liver biopsy? Even without taking into account the complications of liver biopsy (three severe complications out of 1000 and three deaths out of 10 000), the cost of the baseline diagnostics could be decreased by using non-invasive biochemical markers of liver features, such as the Fibrotest-Actitest, which costs only 90 euros.2,3
Conflict of interest: T Poynard has participated in clinical trials for viral hepatitis and as an advisor with the following companies: BMS, Boehringer, Gilead Science, GlaxoSmithKline, Idenix, Roche, and Schering Plough. He is a consultant and has financial participation in the capital of Biopredictive (start up company from Bioincubator ParisBiotech, University Paris 5), which is is marketing Fibrotest and Actitest.
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