title: Cost-effectiveness analysis of therapeutic strategies for patients with chronic hepatitis C previously not responding to interferon.
abstract: BACKGROUND
  The efficacy of combination therapy in patients with chronic hepatitis C previously not responding to interferon monotherapy is lower than that in naive patients, and there has been no economic evaluation in this population.
  
  
  OBJECTIVE
  To develop a cost-effectiveness analysis of therapeutic regimens with interferon-alpha and ribavirin in previous interferon non-responders.
  
  
  METHODS
  A Markov simulation model was used to project the clinical and economic outcomes of five different therapeutic strategies, including a 'no treatment' alternative, using the health care system perspective. The efficacy data for the different doses and durations were obtained from a previously performed meta-analysis. A sensitivity analysis was performed to test the robustness of the model, analysing changes in different variables.
  
  
  RESULTS
  Applying a 3% discount rate, the standard patient on combination therapy for 12 months showed increases of 0.80 years and 1.55 quality-adjusted life years, when compared with the 'no treatment' strategy. This option led to an incremental cost-effectiveness ratio of 11,767 euros per year of life gained and 6073 euros per quality-adjusted life year.
  
  
  CONCLUSIONS
  Combination therapy with interferon plus ribavirin is cost-effective in previous interferon non-responders and is within the range of some well-accepted medical interventions in our health care system.
authors.affiliation: Pharmacy Services, Hospital General de Soria, Spain. rselita@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: San Miguel
authors.forename: J
authors.initials: J
authors.lastname: Mar
authors.forename: J M
authors.initials: JM
authors.lastname: Cabasés
authors.forename: F
authors.initials: F
authors.lastname: Guillén-Grima
authors.forename: M
authors.initials: M
authors.lastname: Buti
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical; D004338:Drug Combinations; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D011788:Quality of Life; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use*; D012680:Sensitivity and Specificity
chemical_list: D000998:Antiviral Agents; D004338:Drug Combinations; D016898:Interferon-alpha; D012254:Ribavirin