title: Assessing the Effect of Potential Reductions in Non-Hepatic Mortality on the Estimated Cost-Effectiveness of Hepatitis C Treatment in Early Stages of Liver Disease.
abstract: BACKGROUND
  Most cost-effectiveness analyses of hepatitis C (HCV) therapy focus on the benefits of reducing liver-related morbidity and mortality.
  
  
  OBJECTIVE
  Our objective was to assess how cost-effectiveness estimates of HCV therapy can vary depending on assumptions regarding the potential impact of HCV therapy on non-hepatic mortality.
  
  
  METHODS
  We adapted a state-transition model to include potential effects of HCV therapy on non-hepatic mortality. We assumed successful treatment could reduce non-hepatic mortality by as little as 0 % to as much as 100 %. Incremental cost-effectiveness ratios were computed comparing immediate treatment versus delayed treatment and comparing immediate treatment versus non-treatment.
  
  
  RESULTS
  Comparing immediate treatment versus delayed treatment, when we included a 44 % reduction in non-hepatic mortality following successful HCV treatment, the incremental cost per quality-adjusted life year (QALY) gained by HCV treatment fell by 76 % (from US$314,100 to US$76,900) for patients with no fibrosis and by 43 % (from US$62,500 to US$35,800) for patients with moderate fibrosis. Comparing immediate treatment versus non-treatment, assuming a 44 % reduction in non-hepatic mortality following successful HCV treatment, the incremental cost per QALY gained by HCV treatment fell by 64 % (from US$186,700 to US$67,300) for patients with no fibrosis and by 27 % (from US$35,000 to US$25,500) for patients with moderate fibrosis.
  
  
  CONCLUSIONS
  Including reductions in non-hepatic mortality from HCV treatment can have substantial effects on the estimated cost-effectiveness of treatment.
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA. aleidner@cdc.gov.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Leidner
authors.affiliation: Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Harrell W
authors.initials: HW
authors.lastname: Chesson
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Spradling
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
mesh_terms: D003362:Cost-Benefit Analysis; D018450:Disease Progression; D017048:Health Care Costs; D006526:Hepatitis C / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D006801:Humans; D008390:Markov Chains; D015233:Models, Statistical; D009026:Mortality; D019057:Quality-Adjusted Life Years