title: Watchful waiting with periodic liver biopsy versus immediate empirical therapy for histologically mild chronic hepatitis C. A cost-effectiveness analysis.
abstract: BACKGROUND
  Not all patients with histologically mild chronic hepatitis C progress to cirrhosis.
  
  
  OBJECTIVE
  To compare no antiviral treatment, periodic liver biopsy with subsequent antiviral treatment for moderate hepatitis or cirrhosis, and immediate antiviral therapy.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  Clinical trial data and published studies.
  
  
  METHODS
  Hepatitis C virus-infected patients with histologically mild hepatitis.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  Immediate combination antiviral treatment or biopsy every 3 years plus combination antiviral therapy for moderate hepatitis or cirrhosis.
  
  
  METHODS
  Life expectancy, quality-adjusted life expectancy, and costs.
  
  
  RESULTS
  Over 20 years, biopsy every 3 years with treatment of moderate hepatitis would avoid treatment in 50% of the cohort and would result in an 18% likelihood of cirrhosis compared with 16% for immediate treatment and 27% for no antiviral therapy. Immediate antiviral treatment should increase life expectancy by 1.0 quality-adjusted life-year compared with biopsy management. Over an average lifetime, biopsy management would lead to six liver biopsies costing $6200; immediate antiviral treatment would cost $5100 less than biopsy management because of savings related to biopsy and prevention of future hepatitis C-related morbidity. Immediate therapy was cost-effective compared with biopsy management and had a cost-effectiveness ratio of $7000 compared with no antiviral therapy.
  
  
  RESULTS
  When age, sex, genotype, and estimates of histologic progression or compliance with follow-up are varied, immediate therapy should result in an increase of at least 0. 8 quality-adjusted life-year compared with biopsy management.
  
  
  CONCLUSIONS
  For histologically mild chronic hepatitis C, initial combination treatment compared with periodic liver biopsy should reduce the future risk for cirrhosis, prolong life, and be cost-effective.
authors.affiliation: New England Medical Center, 750 Washington Street, Box 302, Boston, MA 02111, USA. jwong@lifespan.org
authors.forename: J B
authors.initials: JB
authors.lastname: Wong
authors.forename: R S
authors.initials: RS
authors.lastname: Koff
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000473:pathology* / Q000821:virology; D006801:Humans; D008017:Life Expectancy; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D009010:Monte Carlo Method; D010349:Patient Compliance; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D000998:Antiviral Agents