Cost-effectiveness of treatment for hepatitis C in an urban cohort co-infected with HIV.
OBJECTIVE
Recent clinical trials have evaluated treatment strategies for chronic infection with hepatitis C virus (HCV) in patients co-infected with human immunodeficiency virus (HIV). Our objective was to use these data to examine the cost-effectiveness of treating HCV in an urban cohort of co-infected patients.


METHODS
A computer-based model, together with available published data, was used to estimate lifetime costs (2004 US dollars), life expectancy, and incremental cost per year of life saved (YLS) associated with 3 treatment strategies: (1) interferon-alfa and ribavirin; (2) pegylated interferon-alfa; and (3) pegylated interferon-alfa and ribavirin. The target population included treatment-eligible patients, based on an actual urban cohort of HIV-HCV co-infected subjects, with a mean age of 44 years, of whom 66% had genotype 1 HCV, 16% had cirrhosis, and 98% had CD4 cell counts >200 cells/mm3.


RESULTS
Pegylated interferon-alfa and ribavirin was consistently more effective and cost-effective than other treatment strategies, particularly in patients with non-genotype 1 HCV. For patients with CD4 counts between 200 and 500 cells/mm3, survival benefits ranged from 5 to 11 months, and incremental cost-effectiveness ratios were consistently less than $75,000 per YLS for men and women of both genotypes. Due to better treatment efficacy in non-genotype 1 HCV patients, this group experienced greater life expectancy gains and lower incremental cost-effectiveness ratios.


CONCLUSIONS
Combination therapy with pegylated interferon-alfa and ribavirin for HCV in eligible co-infected patients with stable HIV disease provides substantial life-expectancy benefits and appears to be cost-effective. Overcoming barriers to HCV treatment eligibility among urban co-infected patients remains a critical priority.
Campos
Nicole G
NG
Program in Health Policy, Harvard University, Cambridge, Mass, USA. gastin@post.harvard.edu
Salomon
Joshua A
JA
Servoss
Julie C
JC
Nunes
David P
DP
Samet
Jeffrey H
JH
Freedberg
Kenneth A
KA
Goldie
Sue J
SJ
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011994:Recombinant Proteins; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D014504:Urban Health
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin