Evaluating the cost of sustained virologic response in naïve chronic hepatitis C patients treated à la carte.
BACKGROUND
There is a tendency to individualize treatment in chronic hepatitis C patients depending on viral load and rapid clearance of HCV-RNA.


OBJECTIVE
To evaluate the cost (euro, 2006) per sustained virologic response in naïve patients with therapy à la carte compared with standard combination therapy.


METHODS
A decision analysis model was used to compare standard therapy with peginterferon alpha and ribavirin for 24 weeks for genotype (G) 2/3, and 48 weeks for G1 and therapy à la carte with the same drugs but different durations: G1 high viral load for 48 weeks, G1 low viral load with rapid virologic response for 24 weeks, and without rapid virologic response for 48 weeks, and G2/3 with rapid virologic response for 12 weeks, and without rapid virologic response for 24 weeks.


RESULTS
Sustained virologic response was similar in both strategies. The cost per successfully treated patient for standard therapy is 17,812 euros and for therapy à la carte 12,313 euros. Assuming that 13,309 patients with standard therapy and 14,450 patients with therapy à la carte achieve sustained virologic response, therapy à la carte has an overall cost-saving of 59.13 million euros.


CONCLUSIONS
Therapy à la carte is a cost-saving strategy for chronic hepatitis C infection compared to standard therapy, with lower investment requirement per patient to achieve sustained virologic response.
Buti
M
M
Department of Hepatology, Hospital Vall d'Hebrón, and CiBER de Enfermedades Hepaticas y Digestivas del Instituto de Salud Carlos III, Barcelona, Spain. mbuti@vhebron.net
Casado
M A
MA
Esteban
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D003363:Cost Control / Q000379:methods; D003663:Decision Trees; D004359:Drug Therapy, Combination; D017850:Economics, Pharmaceutical; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use*; D012680:Sensitivity and Specificity
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b