title: Using competence network collaboration and decision-analytic modeling to assess the cost-effectiveness of interferon alpha-2b plus ribavirin as initial treatment of chronic hepatitis C in Germany.
abstract: The objective of this study was to translate and apply a decision-analytic model for chronic hepatitis C (CHC) to the German health care context using competence network collaboration. The German Hepatitis C Model (GEHMO) competence network used a systematic multistep approach to identify and transfer a high quality Markov model for CHC to the German health care context. GEHMO was used to project lifetime clinical and economic outcomes and to determine the cost-effectiveness of initial antiviral therapy with interferon a-2b plus ribavirin from a societal perspective. In 40-year-old patients combination therapy for 24 and 48 weeks increased life expectancy by 1.6 and 2.3 years, respectively, compared with interferon alone for 48 weeks. The discounted incremental cost-utility ratios (ICUR) for combination therapy were euro 5,500 per quality-adjusted life-year gained (QALY) for 24 weeks and euro 6,800/QALY for 48 weeks of treatment. ICUR was euro 9,800/QALY for moving from 24 to 48 weeks of treatment. Combination therapy remained cost-effective in sensitivity analyses. In conclusion, combination therapy with interferon alpha-2b and ribavirin is effective and cost-effective compared with other well-accepted medical treatments. Competence network collaboration and decision modeling provide a useful and efficient approach to combine evidence from international studies with country-specific parameters.
authors.affiliation: Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., USA. usiebert@hsph.harvard.edu
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Gaby
authors.initials: G
authors.lastname: Sroczynski
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Greiner
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ravens-Sieberer
authors.forename: Pamela
authors.initials: P
authors.lastname: Aidelsburger
authors.forename: Bärbel M
authors.initials: BM
authors.lastname: Kurth
authors.forename: Monika
authors.initials: M
authors.lastname: Bullinger
authors.forename: J-Matthias Graf
authors.initials: JM
authors.lastname: von der Schulenburg
authors.forename: John B
authors.initials: JB
authors.lastname: Wong
authors.forename: Siegbert
authors.initials: S
authors.lastname: Rossol
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003657:Decision Making; D004359:Drug Therapy, Combination; D005858:Germany; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics* / Q000627:therapeutic use; D008017:Life Expectancy; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins; D012254:Ribavirin / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin