Cost-effectiveness of pegylated interferon and ribavirin for patients with chronic hepatitis C treated in routine clinical practice

• Published in: International journal of technology assessment in health care 2009-04, Vol.25 (2), p.171-180
• Main Authors: Grishchenko, Marina, Grieve, Richard D., Sweeting, Michael J., De Angelis, Daniela, Thomson, Brian J., Ryder, Stephen D., Irving, William L.
• Format: Article
• Language: English
• Subjects: Adult; Age; Alcohol use; Antiviral Agents - economics; Antiviral Agents - therapeutic use; Antiviral therapy; Biopsy; Chronic hepatitis C; Clinical medicine; Cohort analysis; Combination therapy; Cost analysis; Cost-Benefit Analysis; Decision Trees; Decision-analytic model; Drug dosages; Drug Therapy, Combination; Estimates; Female; Genotype & phenotype; Health Care Costs; Hepatitis C; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; Humans; Infections; Interferon; Interferon-alpha - economics; Interferon-alpha - therapeutic use; Liver; Liver cancer; Liver cirrhosis; Male; Markov Chains; Middle Aged; Patients; Polyethylene Glycols - economics; Polyethylene Glycols - therapeutic use; Probability; Quality of life; Quality-Adjusted Life Years; Recombinant Proteins; Regression analysis; Ribavirin - economics; Ribavirin - therapeutic use; Routine data
• ISSN: 0266-4623; 1471-6348
• DOI: 10.1017/S0266462309090229

Objectives: This study assesses whether pegylated interferon and ribavirin is cost-effective compared with no antiviral treatment provided in routine clinical practice, for different patient subgroups. Methods: The cost-effectiveness analysis (CEA) uses a Markov decision model to estimate the lifetime cost per quality-adjusted life-year (QALY) of antiviral treatment compared with no treatment. The model is populated with data on sustained virological responses, costs, and transition probabilities all taken from a large representative sample of UK cases and centers (Trent HCV database). Results: The CEA found that pegylated interferon and ribavirin was cost-effective for most patient subgroups. The CEA found that for patients with genotype non-1, the intervention led to cost reductions and gains of at least 0.5 QALYs. For genotype 1 cases with mild or moderate disease, and younger cirrhotic patients (aged 40 or less), costs per QALY remained below £20,000 ($40,000 or €29,000). For genotype 1 cases with cirrhosis aged 50, the mean cost per QALY rose to over £60,000 ($120,000 or €87,000). Conclusions: The study concludes that, based on cost and effectiveness data collected from routine clinical practice, treatment with pegylated interferon and ribavirin is generally cost-effective. The study shows that there are variations according to patient subgroup and for older (aged 50 or over) genotype 1 patients with cirrhosis, antiviral treatment appears less cost-effective.