Cost-effectiveness of truncated therapy for hepatitis C based on rapid virologic response.

Published

Journal Article

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.To assess the cost-effectiveness of response-guided therapy versus standard-duration therapy on the basis of best available evidence.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.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.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.

Full Text

Duke Authors

Cited Authors

  • Gellad, ZF; Muir, AJ; McHutchison, JG; Sievert, W; Sharara, AI; Brown, KA; Flisiak, R; Jacobson, IM; Kershenobich, D; Manns, MP; Schulman, KA; Reed, SD

Published Date

  • September 2012

Published In

Volume / Issue

  • 15 / 6

Start / End Page

  • 876 - 886

PubMed ID

  • 22999138

Pubmed Central ID

  • 22999138

Electronic International Standard Serial Number (EISSN)

  • 1524-4733

International Standard Serial Number (ISSN)

  • 1098-3015

Digital Object Identifier (DOI)

  • 10.1016/j.jval.2012.06.010

Language

  • eng