title: The cost of treating ribavirin-induced anemia in hepatitis C: the impact of using recombinant human erythropoietin.
abstract: OBJECTIVE
  Ribavirin-induced anemia (RIA) is a common adverse effect of chronic hepatitis C treatment. Studies have shown that the use of epoetin decreases the need for ribavirin dose reduction or discontinuation. The primary objective was to calculate the incremental cost of treating hepatitis C in those without versus with RIA, using either the strategy of ribavirin dose reduction/discontinuation or epoetin. The secondary objective was to calculate the incremental cost of using epoetin versus no epoetin to treat RIA, per ribavirin dose reduction/discontinuation averted.
  
  
  METHODS
  Estimates from the literature and decision-analytic techniques were used to model treatment patterns and estimate the cost of managing RIA in genotype 1, 2, and 3 subjects. Sensitivity analyses were used to address uncertainty.
  
  
  RESULTS
  Clinically significant RIA, a reduction in hemoglobin of > or = 2 g/dL (1.2 mmol/L), developed in 72% of patients in observational studies. The incremental cost of treating chronic hepatitis C decreased when employing the strategy of ribavirindose reduction/discontinuation to treat RIA, and increased by 5.7% (genotype 1) or 34.4% (genotype 2 or 3), when using epoetin. Using one-way sensitivity analyses, the cost of using epoetin per ribavirin dose reduction/discontinuation averted was $39,579-$52,023. Generalizability may be limited to settings in which a similar proportion of patients develop RIA.
  
  
  CONCLUSIONS
  The proportional cost of treating hepatitis C when using epoetin to treat RIA is significant in genotype 2 or 3 patients. The cost of using epoetin per ribavirin dose reduction/discontinuation averted is substantial in patients with genotypes 1, 2, or 3; and varies with the probability of response to epoetin. These findings suggest that additional studies are warranted that will determine the effect of epoetin on treatment outcomes and its role as supportive therapy in patients with RIA.
authors.affiliation: University of Washington Department of Pharmacy, Seattle, WA 98195-7630, USA. bdevine@u.washington.edu
authors.forename: E B
authors.initials: EB
authors.lastname: Devine
authors.forename: J T
authors.initials: JT
authors.lastname: Cross
authors.forename: K V
authors.initials: KV
authors.lastname: Kowdley
authors.forename: S D
authors.initials: SD
authors.lastname: Sullivan
mesh_terms: D000465:Algorithms; D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy* / Q000191:economics*; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use*; D005838:Genotype; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006526:Hepatitis C / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D008962:Models, Theoretical; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D012254:Ribavirin