title: Costs and outcomes of treating chronic hepatitis C patients in routine care - results from a nationwide multicenter trial.
abstract: Viral hepatitis is a major public health problem affecting millions of people worldwide. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The aim of the study was to assess outcomes and costs of treating patients with chronic hepatitis C in clinical practice in Germany. We carried out a prospective noninterventional study. Information on treatment outcomes, resource utilization and quality of life was provided by 281 physicians throughout Germany. Data of 3708 monoinfected HCV-patients treated between 2008 and 2011 were analysed. Therapy consisted of peginterferon/ribavirin. Mean age of patients was 43.7 years, 60.3% were male and estimated duration of infection was 13.6 years. Predominantly genotype 1 (61.3%) or 3 (28.5%) infections were observed. Sustained viral response (SVR)-rates in most frequently observed genotypes were 49.2% in GT-1 and 61.9% in GT-3 treatment-naive patients (Relapser: GT-1: 35.3% and GT-3: 57.3%; Nonresponder: GT-1: 25.0% and GT-3: 33.3%). Average treatment costs were lowest in treatment-naive patients (€18 965) and higher in patients who failed previous treatments (relapsers: €24 753; nonresponders: €19 511). Differences according to genotype were observed. Average costs per SVR in treatment-naive patients were €44 744 for GT-1 and €22 218 for GT-3. Treatment was associated with a decrease in quality of life; post-treatment quality of life was higher in patients achieving SVR. Our insight on real-life treatment outcomes and costs can serve as a reference for a comparison with other treatments. There is high need for short-term and long-term cost-effectiveness analysis in real-life settings as newly introduced treatment strategies with direct acting antivirals result in high SVR-rates but are more costly.
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
authors.forename: J T
authors.initials: JT
authors.lastname: Stahmeyer
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Krauth
authors.affiliation: Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Bert
authors.affiliation: Factum - Company for Statistics, Scientific Information and Communication mbH, Offenbach, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Pfeiffer-Vornkahl
authors.affiliation: Virology, Roche Pharma AG, Grenzach-Wyhlen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Alshuth
authors.affiliation: Center of Gastroenterology, Herne, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Hüppe
authors.affiliation: Center for HIV and Hepatogastroenterology, Duesseldorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Mauss
authors.affiliation: Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Rossol
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D005838:Genotype; D005858:Germany; D017048:Health Care Costs; D016174:Hepacivirus / Q000187:drug effects*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008297:Male; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: antiviral treatment; clinical practice; costs; effectiveness; health economics; hepatitis C