title: Cost-effectiveness analysis of adding low dose ribavirin to peginterferon alfa-2a for treatment of chronic hepatitis C infected thalassemia major patients in iran.
abstract: BACKGROUND
  The prevalence of hepatitis C in Iran is 1% and 18% in general population and thalassemia patients respectively. The cost effectiveness analysis of adding Ribavirin to Peginterferon alfa-2a (PEG IFN alfa-2a) as a combination treatment strategy of chronic hepatitis C in thalassemia patients in comparison with monotherapy could help clinicians and policy makers to provide the best treatment for the patients.
  
  
  OBJECTIVE
  In this study we aimed to assess whether adding Ribavirin to PEG IFN alfa-2a is a cost effective strategy in different genotypes and different subgroups of 280 patients with chronic hepatitis C infection from the perspective of society in Iranian setting.
  
  
  METHODS
  A cost effectiveness analysis including all costs and outcomes of treatments for chronic hepatitis C infected thalassemia major patients was conducted. We constructed a decision tree of treatment course in which a hypothetical cohort of 100 patients received "PEG IFN alfa-2a" or "Peg IFN alfa-2a plus Ribavirin." The cost analysis was based on cost data for 2008 and we used 9300 Iranian Rials (IR Rial) as exchange rate declared by the Iranian Central Bank on that time to calculating costs by US Dollar (USD). To evaluate whether a strategy is cost effective, one time and three times of GDP per capita were used as threshold based on recommendation of the World Health Organization.
  
  
  RESULTS
  The Incremental Cost Effectiveness Ratio (ICER) for combination therapy in genotype-1 and genotypes non-1 subgroups was 2,673 and 19,211 US dollars (USD) per one Sustain Virological Response (SVR), respectively. In low viral load and high viral load subgroups, the ICER was 5,233 and 14,976 USD per SVR, respectively. The calculated ICER for combination therapy in subgroup of patients with previously resistant to monotherapy was 13,006 USD per SVR. Combination therapy in previously resistant patients to combination therapy was a dominant strategy.
  
  
  CONCLUSIONS
  Adding low dose of Ribavirin to PEG IFN alfa-2a for treatment of chronic hepatitis C patients with genotype-1 was "highly cost effective" and in patients with low viral load and in previous monotherapy resistant patients was "cost effective."
authors.affiliation: Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah Hospital, Tehran, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mehrazmay
authors.forename: Seyed Moayed
authors.initials: SM
authors.lastname: Alavian
authors.forename: Maziar
authors.initials: M
authors.lastname: Moradi-Lakeh
authors.forename: Mahdi
authors.initials: M
authors.lastname: Mokhtari Payam
authors.forename: Amir
authors.initials: A
authors.lastname: Hashemi-Meshkini
authors.forename: Bita
authors.initials: B
authors.lastname: Behnava
authors.forename: Seyyed Mohammad
authors.initials: SM
authors.lastname: Miri
authors.forename: Pegah
authors.initials: P
authors.lastname: Karimi Elizee
authors.forename: Seyed Vahid
authors.initials: SV
authors.lastname: Tabatabaee
authors.forename: Maryam
authors.initials: M
authors.lastname: Keshvari
authors.forename: Kamran
authors.initials: K
authors.lastname: Bagheri Lankarani
keywords: Cost-Benefit Analysis; Decision Support Techniques; Hepatitis C; Iran; PEG-Interferon Alfa-2a; Ribavirin