Cost-effectiveness of interferon ? or peginterferon ?, with ribavirin for histologically mild chronic hepatitis C

Grieve, Richard, Roberts, Jennifer, Wright, Mark, Sweeting, Michael, DeAngelis, Daniela, Rosenberg, William, Bassendine, Margaret, Main, Janice and Thomas, Howard (2006) Cost-effectiveness of interferon ? or peginterferon ?, with ribavirin for histologically mild chronic hepatitis C. Gut, 55 (9), 1332-1338. (doi:10.1136/gut.2005.064774).

Abstract

Background: For patients with mild chronic hepatitis C the cost-effectiveness of antiviral therapy is unknown.
Aims: To assess whether anti-viral therapy (either interferon α or peginterferon α combined with ribavirin) is cost-effective at a mild stage compared to waiting and only treating those cases who progress to moderate disease.
Patients: Cases with mild chronic hepatitis C.
Methods: A cost-effectiveness model estimates long-term costs and outcomes for patients with mild chronic hepatitis C. The model uses effectiveness and cost data from the UK mild hepatitis C RCT, combined with estimates of disease progression and cost from observational studies.
Results: Antiviral treatment at a mild rather than a moderate stage improved outcomes measured by Quality Adjusted Life Years (QALYs) gained. The mean cost per QALY gained from antiviral treatment with interferon α-2b and ribavirin, compared to no treatment at a mild stage, was £4,535 ($7,108) for patients with genotype non-1 and £25,188 ($39,480) for patients with genotype 1. Providing peginterferon α-2b and ribavirin at a mild rather than a moderate stage was also associated with a gain in QALYs; the costs per QALY gained were £7,821 ($12,259) for patients with genotype non-1 and £28,409 ($44,528) for patients with genotype 1.
Conclusions: For patients with chronic hepatitis C, it is generally more cost-effective to provide antiviral treatment at a mild rather than a moderate disease stage. For older patients (aged 65 or over) with genotype 1, antiviral treatment at a mild stage is not cost-effective.

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