Cost-effectiveness of 6 and 12 months of interferon-alpha therapy for chronic hepatitis C.
BACKGROUND
Interferon-alpha is effective in only a small number of patients with chronic hepatitis C, although prolonged treatment may increase the response rate. There is concern that the expense of interferon-alpha therapy may not be justified by the low response rates and uncertain long-term benefit.


OBJECTIVE
To compare clinical and economic outcomes after 6 months and 12 months of interferon-alpha therapy for chronic hepatitis C.


METHODS
A Markov model depicting the natural progression of chronic hepatitis C. On the basis of this model, a simulated trial compared no therapy with 6 and 12 months of interferon-alpha therapy at standard doses (3 million U three times weekly).


METHODS
Four age-specific cohorts (30, 40, 50, and 60 years of age) with chronic hepatitis C.


METHODS
Number of deaths from liver disease, total costs, and cumulative quality-adjusted life-years (QALYs).


RESULTS
Six and 12 months of interferon-alpha treatment gained 0.25 QALYs at an incremental cost of $1000 and 0.37 QALYs at an incremental cost of $1900, respectively. Thus, although 6 months of interferon-alpha therapy was less efficacious than 12 months of therapy, it was more cost-effective ($4000 per QALY gained compared with $5000 per QALY gained). Nonetheless, in patients younger than 60 years of age, both 6 and 12 months of therapy compared favorably with other established medical interventions, such as screening mammography and cholesterol reduction programs. Important variables affecting the cost-effectiveness of interferon-alpha treatment included the cost and efficacy of interferon-alpha, the cost of treatment for decompensated cirrhosis, and quality of life in patients with chronic hepatitis C.


CONCLUSIONS
From the standpoint of cost-effectiveness, interferon-alpha therapy for 6 or 12 months may be justified in patients with chronic hepatitis C. The possible exception is patients older than 60 years of age.
Kim
W R
WR
Mayo Clinic, Rochester, Minnesota, USA.
Poterucha
J J
JJ
Hermans
J E
JE
Therneau
T M
TM
Dickson
E R
ER
Evans
R W
RW
Gross
J B
JB
D000328:Adult; D000367:Age Factors; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004334:Drug Administration Schedule; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000191:economics*; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000998:Antiviral Agents; D016898:Interferon-alpha