Cost-effectiveness of 24 or 48 weeks of interferon alpha-2b alone or with ribavirin as initial treatment of chronic hepatitis C. International Hepatitis Interventional Therapy Group.
OBJECTIVE
Initial therapy with ribavirin and interferon alpha-2b results in a higher sustained virological response than interferon alone, but this regimen is expensive. We aimed to examine the cost-effectiveness of 24- or 48-wk initial treatment with combination therapy versus interferon alone for patients who have chronic hepatitis C.


METHODS
Data from recent randomized clinical trials comparing combination therapy to interferon alone were applied to a previously published computer cohort simulation to project lifelong clinical and economic outcomes. Natural history and economic estimates were based on published literature, expert panel estimates, and actual variable cost and reimbursement data.


RESULTS
Using treatment stopping rules, sustained viral negative response rates would be 33.1% and 39.8% for patients receiving 24 versus 48 wk of ribavirin/interferon, compared with 14.3% for 48 wk of interferon alone. Compared to the interferon alone strategy, 24 or 48 wk of combination therapy should prolong life expectancy by 1.4 to 2.0 yr at marginal cost-effectiveness ratios of $4,400 to $5,400 per discounted quality-adjusted life-year (DQALY) gained. Compared to 24 wk of combination therapy, 48 wk of combination therapy should prolong life expectancy by 0.6 yr at a marginal cost-effectiveness ratio of $7,700 per DQALY gained. The results were robust, with 24 or 48 wk of combination therapy remaining preferred and cost-effective in sensitivity analysis compared with interferon alone.


CONCLUSIONS
For patients with chronic hepatitis C, 24 or 48 wk of ribavirin and interferon should prolong life and be cost-effective when compared with 48 wk, of interferon alone.
Wong
J B
JB
Department of Medicine, Tupper Research Institute, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
Poynard
T
T
Ling
M H
MH
Albrecht
J K
JK
Pauker
S G
SG
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D013997:Time Factors
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin