title: Real-life costs of hepatitis C treatment.
abstract: BACKGROUND
  Hepatitis C virus infection is a serious health threat in today's society. Improved identification strategies have increased the number of patients undergoing the expensive treatment with ribavirin and peg-interferon, inducing a substantial economic burden.
  
  
  METHODS
  In a retrospective cohort study in three treatment centres in the Netherlands, files of patients treated between 2001 and 2010 were systematically searched for all cost-inducing treatment details. Costs of treatment resulting in sustained viral response (SVR), relapse, non-response and the costs per cured patient were specified for genotype and treatment setting. Determinants of costs were determined by multivariate linear regression.
  
  
  RESULTS
  The mean 'real-life' treatment costs excluding side effects for genotype 1/4 and genotype 2/3 were approximately € 12,900 and € 9900 for all patients, € 15,500 and € 10,100 for treatment resulting in SVR and € 16,800 and € 12,100 for relapse, respectively. Costs per cured patient were € 28,500 and € 15,400 respectively. The costs of non-response were approximately € 8000 for all genotypes. Costs of side effects can be high and are mainly caused by incidental treatment for neutropenia. Medication is the main component of treatment costs. Treatment costs were higher in the academic setting due to longer duration and higher costs of side effects. Regression analysis confirms duration as the main determinant of treatment costs excluding side effects.
  
  
  CONCLUSIONS
  The 'real-life' costs of treatment are mainly determined by treatment duration, medication costs and costs of side effects. The costs of unsuccessful treatment are considerable as are the costs of side effects. Therefore, future research should aim at increasing SVR rates, reducing treatment duration and preventing side effects.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands. C.W.Helsper-2@UMCUtrecht.nl
authors.forename: C W
authors.initials: CW
authors.lastname: Helsper
authors.forename: H L
authors.initials: HL
authors.lastname: Hellinga
authors.forename: G A
authors.initials: GA
authors.lastname: van Essen
authors.forename: G A
authors.initials: GA
authors.lastname: de Wit
authors.forename: M J M
authors.initials: MJ
authors.lastname: Bonten
authors.forename: K J
authors.initials: KJ
authors.lastname: van Erpecum
authors.forename: A I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: C
authors.initials: C
authors.lastname: Richter
authors.forename: N J
authors.initials: NJ
authors.lastname: de Wit
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D008297:Male; D009426:Netherlands; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a