title: Cost-effectiveness of 6 and 12 months of interferon-alpha therapy for chronic hepatitis C.
abstract: 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.
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Kim
authors.forename: J J
authors.initials: JJ
authors.lastname: Poterucha
authors.forename: J E
authors.initials: JE
authors.lastname: Hermans
authors.forename: T M
authors.initials: TM
authors.lastname: Therneau
authors.forename: E R
authors.initials: ER
authors.lastname: Dickson
authors.forename: R W
authors.initials: RW
authors.lastname: Evans
authors.forename: J B
authors.initials: JB
authors.lastname: Gross
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha