Treatment for hepatitis C virus in human immunodeficiency virus-infected patients: clinical benefits and cost-effectiveness.
BACKGROUND
Hepatitis C virus (HCV) is an important cause of liver disease in human immunodeficiency virus (HIV)-infected patients.


OBJECTIVE
To assess the cost-effectiveness of alternative management strategies for chronic HCV in co-infected patients with moderate hepatitis.


METHODS
A state-transition model was used to simulate a cohort of HIV-infected patients with a mean CD4 cell count of 350 cells/ micro L and moderate chronic hepatitis C stratified by genotype. Strategies included interferon alfa (48 weeks), pegylated interferon alfa (48 weeks), interferon alfa and ribavirin (24 and 48 weeks), pegylated interferon alfa and ribavirin (48 weeks), and no treatment. Outcomes included life expectancy, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios.


RESULTS
Treatment for moderate chronic HCV with combination therapy using an interferon-based regimen reduced the incidence of cirrhosis and provided gains in quality-adjusted life expectancy ranging from 6.2 to 13.9 months, depending on genotype. Regardless of genotype, the cost-effectiveness of interferon alfa and ribavirin for patients with moderate hepatitis was lower than $50 000 per QALY vs the next best strategy. With genotype 1, pegylated interferon alfa (vs interferon alfa) and ribavirin therapy provided an additional 1.6 quality-adjusted life-months for $40 000 per QALY. Because treatment is more effective with non-1 genotypes, pegylated interferon (vs interferon alfa) and ribavirin provided only 3 additional quality-adjusted life-months for $105 300 per QALY. For patients who were intolerant of ribavirin, monotherapy with pegylated interferon was always the most cost-effective option.


CONCLUSIONS
Combination therapy for moderate hepatitis in coinfected patients will increase quality-adjusted life expectancy and have a cost-effectiveness ratio comparable to that of other well-accepted clinical interventions.
Kuehne
Felicitas C
FC
Harvard Program on the Economic Evaluation of Medical Technology, 718 Huntington Ave, Second Floor, Boston, MA 02115-5924, USA.
Bethe
Ullrich
U
Freedberg
Kenneth
K
Goldie
Sue J
SJ
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000191:economics; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D011788:Quality of Life; D011994:Recombinant Proteins; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins