title: Cost-effectiveness of hematologic growth factors for anemia occurring during hepatitis C combination therapy.
abstract: In hepatitis C virus (HCV)-infected patients who develop anemia during combination therapy, erythropoietic growth factors maintain higher drug treatment levels compared to ribavirin dose reduction, which may lead to an increase in treatment response rates. This study estimated the cost-effectiveness of growth factor therapy in maintaining anemic HCV-infected patients on target drug levels during combination therapy. A decision analysis using a Markov model was developed with 7 health states: Sustained viral response, chronic HCV, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, and death. Data sources included population-based studies of growth factor therapy, previously published estimates of costs and natural history of hepatitis C, and recent prospective studies. Our reference case was a 45-year-old Caucasian man with HCV infection (genotype 1, 2, or 3) who developed anemia while undergoing combination therapy with ribavirin and pegylated interferon. We compared growth factor injections (darbepoetin alpha or epoetin alpha) during combination therapy with standard ribavirin dose reduction. Compared to a ribavirin dose reduction strategy, the cost of darbepoetin per additional quality-adjusted life-year was 34,793 dollars for genotype 1 and 33,832 dollars for genotypes 2 or 3 versus 60,600 dollars and 64,311 dollars for epoetin. For all genotypes, the results were sensitive to changes in the cure rates of HCV therapy, the utility of chronic HCV, the costs of growth factors, and the age at which therapy is begun. In conclusion, use of erythropoietic growth factors, specifically darbepoetin, for patients with anemia occurring during HCV combination therapy appears to be cost-effective for genotypes 1, 2, or 3.
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospitals of Cleveland, Cleveland, OH, USA. Richard.delrio@case.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Del Rio
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Post
authors.forename: Mendel E
authors.initials: ME
authors.lastname: Singer
mesh_terms: D000740:Anemia / Q000139:chemically induced* / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D000068256:Darbepoetin alfa; D003663:Decision Trees; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000191:economics* / Q000627:therapeutic use*; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D007372:Interferons / Q000009:adverse effects; D008390:Markov Chains; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D011788:Quality of Life; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols; D012254:Ribavirin; D007372:Interferons; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a