Cost-effectiveness of chronic hepatitis C treatment with thymosin alpha-1.
BACKGROUND
More than one million individuals in Mexico are infected with hepatitis C virus (HCV), and 80% are at risk for developing a chronic infection that could lead to hepatic cirrhosis and other complications that impact quality of life and institutional costs. The objective of the study was to determine the most cost-effective treatment against HCV among the following: peginterferon, peginterferon plus ribavirin, peginterferon plus ribavirin plus thymosin, and no treatment.


METHODS
We carried out cost-effectiveness analysis using the institutional perspective, including a 45-year time frame and a 3% discount rate for costs and effectiveness. We employed a Bayesian-focused decision tree and a Markov model. One- and two-way sensitivity analyses were performed, as well as threshold-oriented and probabilistic analyses, and we obtained acceptability curves and net health benefits.


RESULTS
Triple therapy (peginterferon plus ribavirin plus thymosin alpha-1) was dominant with lower cost and higher utility in relationship with peginterferon + ribavirin option, peginterferon alone and no-treatment option. In triple therapy the cost per unit of success was of 1,908 [USD/quality-adjusted life years (QALY)] compared with peginterferon plus ribavirin 2,277/QALY, peginterferon alone 2,929/QALY, and no treatment 4,204/QALY. Sensitivity analyses confirmed the robustness of the base case.


CONCLUSIONS
Peginterferon plus ribavirin plus thymosin alpha-1 option was dominant (lowest cost and highest effectiveness). Using no drug was the most expensive and least effective option.
García-Contreras
Fernando
F
Unidad de Investigación en Economía de la Salud, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico. fernando.garciacon@imss.gob.mx
Nevárez-Sida
Armando
A
Constantino-Casas
Patricia
P
Abud-Bastida
Fernando
F
Garduño-Espinosa
Juan
J
D000276:Adjuvants, Immunologic / Q000191:economics* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008800:Mexico; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D000077596:Thymalfasin; D013947:Thymosin / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D000276:Adjuvants, Immunologic; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D013947:Thymosin; C100416:peginterferon alfa-2a; D000077596:Thymalfasin