Cost effectiveness of combination therapy for hepatitis C: a decision analytic model.
OBJECTIVE
To estimate the cost utility of treatment with combination therapy (ribavirin and interferon alpha) for hepatitis C compared with no treatment or monotherapy (interferon alpha) based on UK costs and clinical management.


METHODS
Decision analysis model using a Markov approach to simulate disease progression.


METHODS
UK secondary care.


METHODS
Hypothetical cohort of patients with hepatitis C.


METHODS
Cost per quality adjusted life year (QALY) gained.


RESULTS
Discounted cost per QALY for combination therapy over no treatment was 3791 pounds. Cost per QALY varied between 1646 pounds and 9170 pounds according to subgroup, with the lowest ratios being for genotype 2 or 3, women, those aged less than 40 years, and those with moderate hepatitis. The discounted cost per QALY of the combination over monotherapy was 3485 pounds. Similar findings were shown for subgroups as for the comparison with no treatment. One way sensitivity analysis showed that while drug costs were more important in the analysis than assumptions about disease progression or costs of treating hepatitis C disease, the results were robust to large changes in underlying assumptions.


CONCLUSIONS
Combination therapy for hepatitis C is a cost effective treatment option and is superior to monotherapy. Considerable uncertainties remain over the appropriate management strategies in the populations excluded from randomised controlled trials and in whom treatment is currently being considered in the UK.
Stein
K
K
University of Exeter, Exeter, UK. ken@kkcats.demon.co.uk
Rosenberg
W
W
Wong
J
J
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004338:Drug Combinations; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006304:Health Status; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use*; D012680:Sensitivity and Specificity
D000998:Antiviral Agents; D004338:Drug Combinations; D016898:Interferon-alpha; D012254:Ribavirin