Cost-effectiveness of combination therapy for naive patients with chronic hepatitis C.
OBJECTIVE
The higher initial cost of combination therapy is a factor which may discourage its use in naive patients with histologically mild or moderate chronic hepatitis C. However, chronic hepatitis C is a slowly progressive disease associated with a decrease in life expectancy and quality of life. The objective of this study was to determine if the incremental sustained response rate of combination therapy is sufficient to outweigh its extra cost.


METHODS
Chronic hepatitis C progression was studied using a Markov model in which cohorts of patients were treated with combination therapy for 6-12 months or with interferon for 12 months. The sustained virological response rates applied were 43, 35 and 19%, respectively, for combination therapy for 12 months, for 6 months and for interferon for 12 months. Costs for each clinical state were calculated according to clinical practice in Spain.


RESULTS
In a 30-year-old patient with moderate chronic hepatitis C, combination therapy for 12 months increases life expectancy by 4.1 years compared with interferon for 12 months. In mild disease, the increase in life expectancy is lower. The cost per life-year saved in patients with chronic hepatitis C ranges from 880 to 64.421 euros depending on the age of the patient, the degree of hepatic lesion and the type and duration of therapy. Compared to other treatments accepted as standard practice in other therapeutic areas, combination therapy for chronic hepatitis C is cost-effective.


CONCLUSIONS
In patients of any age with moderate chronic hepatitis C and those with mild disease under 50 years of age, combination therapy for 12 months is the most cost-effective schedule, whereas in older patients with mild hepatitis, combination therapy for 6 months is the preferred option based on cost-effectiveness criteria.
Buti
M
M
Department of Hepatology, Hospital Vall d'Hebrón, Barcelona, Spain. mbuti@hg.vhebron.es
Casado
M A
MA
Fosbrook
L
L
Wong
J B
JB
Esteban
R
R
D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D008875:Middle Aged; D013030:Spain
D000998:Antiviral Agents