Productivity improvements in hepatitis C treatment: impact on efficacy, cost, cost-effectiveness and quality of life.
OBJECTIVE
The treatment of chronic hepatitis C has advanced considerably during the past 15 years. The aim of this study was to evaluate the impact of different key developments from a health-economic perspective.


METHODS
Costs and health-related quality-of-life data from a follow-up of Swedish patients treated for hepatitis C in clinical practice were used together with clinical trial data and natural history data in order to create a mathematical model that could be used to evaluate the advancement in hepatitis C therapy. The efficacy of treatment, costs and cost-effectiveness were evaluated for both current as well as proposed treatment strategies. A sensitivity analysis was used to assess how results were affected when key variables changed.


RESULTS
Current genotype-guided pegylated interferon and ribavirin is a cost-effective treatment strategy. A proposed treatment strategy involving a reduction in the length of treatment for certain patient subgroups with genotypes 1, 2 and 3, as well as an increase in the length of treatment for patients with genotype 1 and slow virological response was estimated to be a cost-effective future treatment alternative. These results were insensitive to changes in costs and risks associated with chronic hepatitis.


CONCLUSIONS
Although the costs for treatment of hepatitis C have increased significantly over the past decade, the improvements have provided the health-care system with cost-effective options in the treatment of patients with chronic hepatitis C.
Lidgren
Mathias
M
Medical Management Centre, Karolinska Institutet, Stockholm, Sweden. mathias.lidgren@hhs.se
Hollander
Anna
A
Weiland
Ola
O
Jönsson
Bengt
B
D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004334:Drug Administration Schedule; D004526:Efficiency; D005260:Female; D005838:Genotype; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019698:Hepatitis C, Chronic / Q000191:economics* / Q000235:genetics / Q000628:therapy; D006801:Humans; D007372:Interferons / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D011788:Quality of Life; D012254:Ribavirin / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons