title: Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response.
abstract: BACKGROUND
  Shortened courses of treatment with pegylated interferon alfa and ribavirin for patients with hepatitis C virus infection who experience rapid virologic response can be effective in appropriately selected patients. The cost-effectiveness of truncated therapy is not known.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of response-guided therapy versus standard-duration therapy on the basis of best available evidence.
  
  
  METHODS
  We developed a decision model for chronic hepatitis C virus infection representing two treatment strategies: 1) standard-duration therapy with pegylated interferon alfa and ribavirin for 48 weeks in patients with genotype 1 or 4 and for 24 weeks in patients with genotype 2 or 3 and 2) truncated therapy (i.e., 50% decrease in treatment duration) in patients with rapid virologic response. Patients for whom truncated therapy failed began standard-duration therapy guided by genotype. We used a Markov model to estimate lifetime costs and quality-adjusted life-years.
  
  
  RESULTS
  In the base-case analysis, mean lifetime costs were $46,623 ± $2,483 with standard-duration therapy and $42,354 ± $2,489 with truncated therapy. Mean lifetime quality-adjusted life-years were similar between the groups (17.1 ± 0.7 with standard therapy; 17.2 ± 0.7 with truncated therapy). Across model simulations, the probability of truncated therapy being economically dominant (i.e., both cost saving and more effective) was 78.6%. The results were consistent when we stratified the data by genotype. In one-way sensitivity analyses, the results were sensitive only to changes in treatment efficacy.
  
  
  CONCLUSIONS
  Truncated therapy based on rapid virologic response is likely to be cost saving for treatment-naive patients with chronic hepatitis C virus infection. Cost-effectiveness varied with small changes in relative treatment efficacy.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA. ziad.gellad@duke.edu
authors.forename: Ziad F
authors.initials: ZF
authors.lastname: Gellad
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
authors.forename: John G
authors.initials: JG
authors.lastname: McHutchison
authors.forename: William
authors.initials: W
authors.lastname: Sievert
authors.forename: Ala I
authors.initials: AI
authors.lastname: Sharara
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Brown
authors.forename: Robert
authors.initials: R
authors.lastname: Flisiak
authors.forename: Ira M
authors.initials: IM
authors.lastname: Jacobson
authors.forename: David
authors.initials: D
authors.lastname: Kershenobich
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics*; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D016174:Hepacivirus / Q000187:drug effects* / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000191:economics* / Q000235:genetics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000008:administration & dosage* / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a