Cost effectiveness analysis of different strategies of management of chronic hepatitis C infection in children.
BACKGROUND
Chronic hepatitis C virus infection in the pediatric patients is commonly encountered by clinicians, and although interferon-based therapy has been shown to be reasonably effective in children no formal economic analysis of such treatment strategies is available.


METHODS
With a Markov cycle tree simulation model, a cost effectiveness analysis was done to compare interferon-based treatment strategies for chronic HCV infection in children with a strategy of no treatment in a cohort of 10-year-old otherwise healthy children. Clinical probabilities used in the model was obtained from available literature, and cost estimates were obtained from two teaching hospitals. Cost per patient, quality-adjusted life years gained in each strategy and incremental cost-effective ratio were the primary outcome measures compared.


RESULTS
In the baseline analysis the treatment strategies dominated the strategy of no treatment. A 12-month treatment strategy was better than the 6-month treatment strategy. Combination therapy for 6 months with interferon and ribavirin was at least equally if not more effective than 12-month monotherapy. All treatment strategies decreased the number of patients developing decompensated cirrhosis, hepatocellular carcinoma and also number of orthotopic liver transplants in the lifetime of the model cohort.


CONCLUSIONS
Interferon-based treatment strategies were more effective in terms of quality-adjusted life years saved and at the same time cheaper when compared with the strategy of no treatment. Combination therapy may be more cost-effective than interferon monotherapy, and clinical trials of combination therapy in pediatric patients are needed.
Sinha
M
M
Department of Pediatrics, Children's Hospital Medical Center of Akron, OH, USA.
Das
A
A
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005069:Evaluation Studies as Topic; D005260:Female; D017048:Health Care Costs; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000628:therapy; D006801:Humans; D007372:Interferons / Q000191:economics* / Q000627:therapeutic use*; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D015233:Models, Statistical; D011788:Quality of Life
D007372:Interferons