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Cost effectiveness of interferon α or peginterferon α with ribavirin for histologically mild chronic hepatitis C
  1. R Grieve1,
  2. J Roberts1,
  3. M Wright2,
  4. M Sweeting3,
  5. D DeAngelis4,
  6. W Rosenberg5,
  7. M Bassendine6,
  8. J Main2,
  9. H Thomas2
  1. 1Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Department of Medicine, Imperial College, London, UK
  3. 3MRC Biostatistics Unit, Cambridge, UK
  4. 4Statistics, Modelling and Bioinformatics Department, Health Protection Agency, London, UK, and MRC Biostatistics Unit, Cambridge, UK
  5. 5Division of Infection Inflammation and Repair, University of Southampton, Southampton, UK
  6. 6School of Clinical Medical Sciences, The Medical School, Newcastle upon Tyne, UK
  1. 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

Abstract

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

Aims: To assess whether antiviral therapy (either interferon α or peginterferon α 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 α-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 α-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.

  • 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
  • cost effectiveness model
  • cost analysis
  • antiviral therapy

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Footnotes

  • Published online first 24 January 2006

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