[Compared efficiency of three strategies of management of chronic hepatitis C. Effect on the risk of cirrhosis 8 years after diagnosis].
OBJECTIVE
The goal of treating chronic hepatitis C with alfa interferon is to eradicate HCV infection. The actual influence of this treatment on the development of cirrhosis is unknown. Moreover, the poor results and the high cost of this treatment have caused a public health problem. Three strategies were evaluated by decision analysis: no treatment (S1), treatment of chronic active hepatitis only (S2), treatment of all chronic hepatitis (S3). For each strategy, we estimated the probability of the occurrence of the following events based on data in the literature: presence of chronic active hepatitis, chronic persistent hepatitis or cirrhosis at the time of diagnosis; discontinuation of interferon because of adverse events; biological response to treatment; incidence of cirrhosis 8 years after diagnosis without treatment or in case of response to treatment.


RESULTS
The risk of cirrhosis was 28.5% with S1, 25.4% with S2, and 25.2% with S3, 8 years after diagnosis. If HCV infection was detected early before cirrhosis, the number of cases of cirrhosis occurring in an 8 year-followup period would be 45,600 with S1, 40,640 with S2, and 40,320 with S3 and the cost of S2 and S3 would be 1.23 10(9) French Francs (FF), and 2.57 10(9) FF, respectively. The mean cost to prevent one case of cirrhosis would vary from 248,000 FF with S2 to 487,000 FF with S3.


CONCLUSIONS
This decision analysis study suggests that the S3 strategy is not suitable for a population of HCV infected patients, because of its low efficiency and high cost.
Michel
P
P
Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Charles-Nicolle, Rouen.
Merle
V
V
Gourier
C
C
Hochain
P
P
Colin
R
R
Czernichow
P
P
D000998:Antiviral Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006526:Hepatitis C / Q000150:complications* / Q000191:economics / Q000473:pathology / Q000628:therapy; D006521:Hepatitis, Chronic / Q000150:complications* / Q000191:economics / Q000473:pathology / Q000628:therapy; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000191:economics / Q000209:etiology* / Q000473:pathology; D013997:Time Factors
D000998:Antiviral Agents; D016898:Interferon-alpha
Efficience comparée de trois stratégies de prise en charge de l'hépatite chronique C. Influence sur le risque de cirrhose à 8 ans.