Cost-effectiveness of growth factors during hepatitis C anti-viral therapy.
BACKGROUND
Although the current standard of care for controlling anaemia and neutropenia during anti-viral therapy for hepatitis C is to use dose reduction of ribavirin and pegylated interferon, respectively, erythropoietin and granulocyte colony-stimulating factor are now being advocated as alternatives to dose reduction.


OBJECTIVE
To determine the cost-effectiveness of erythropoietin and granulocyte colony-stimulating factor as an alternative to anti-viral dose reduction during antihepatitis C therapy.


METHODS
Decision analysis was used to assess cost-effectiveness by estimating the cost of using a growth factor per quality-adjusted life-year gained.


RESULTS
Under baseline assumptions, the cost per quality-adjusted life-year of using growth factors ranged from 16,247 US dollars for genotype 1 with neutropenia to 145,468 US dollars for genotype 2/3 patients with anaemia. These findings are sensitive to the relationship between dose reduction and sustained virological response.


CONCLUSIONS
Based upon our findings and the varying strength of the evidence for a relationship between dose reduction and sustained virological response: granulocyte colony-stimulating factor may be cost-effective for genotype 1 patients; erythropoietin is probably not cost-effective for genotype 2/3 patients; no conclusion can be reached regarding the cost-effectiveness of erythropoietin for genotype 1 patients or granulocyte colony-stimulating factor for genotype 2/3 patients. Randomized trials are needed to firmly establish the relationship between dose reduction and sustained virological response.
Chapko
M K
MK
Northwest Hepatitis C Resource Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA. chapko@u.washington.edu
Dominitz
J A
JA
D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000191:economics; D003661:Decision Support Techniques; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use; D005838:Genotype; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use; D006526:Hepatitis C / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D016896:Treatment Outcome
D000998:Antiviral Agents; D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor