A health economic model to assess the cost-effectiveness of pegylated interferon alpha-2a and ribavirin in patients with moderate chronic hepatitis C and persistently normal alanine aminotransferase levels.
OBJECTIVE
The treatment of patients with moderate chronic hepatitis C and persistently normal alanine aminotransferase levels is still under discussion and the cost-effectiveness of such strategy is unknown. The objective of this study was to estimate the cost-effectiveness of their treatment in comparison with no treatment.


METHODS
The assessed treatment is composed of pegylated interferon alpha-2a and ribavirin, which is the current standard treatment. Two groups were studied: patients with genotype 1 and patients with genotypes 2-3. At the beginning of the study, patients were aged of 45. Long-term economic and clinical outcomes over a 30 year period were predicted using a Markov simulation model. A health care payer perspective was chosen. Data were obtained from published literature. Variations of uncertainty parameters were assessed through a sensitivity analysis.


RESULTS
The incremental cost-effectiveness ratios (ICERs) were Euro 5,338/QALY for genotype 1 and Euro 1,080/QALY for genotypes 2-3. In the sensitivity analysis, ratios remained lower than Euro 20,000. A Monte Carlo simulation with 1,000 iterations gives a 95% confidence interval for the ICER of Euro 3,199 to Euro 8,972 for genotype 1 and Euro 56 to Euro 1,981 for genotypes 2-3.


CONCLUSIONS
Even though the treatment of these patients generates a cost, it has the advantage that in comparison with no treatment, a great number of people are cured, complications are less frequent and patients gain more quality-adjusted life-year (QALY), which involves an ICER considered as acceptable for the European society (< Euro 20,000).
Gerkens
Sophie
S
Université catholique de Louvain, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
Nechelput
Myriam
M
Annemans
Lieven
L
Peraux
Bénédict
B
Beguin
Claire
C
Horsmans
Yves
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004337:Drug Carriers; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics / Q000201:enzymology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D012367:RNA, Viral / Q000187:drug effects / Q000235:genetics; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000998:Antiviral Agents; D015415:Biomarkers; D004337:Drug Carriers; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D000410:Alanine Transaminase; C100416:peginterferon alfa-2a