 |
|
Cost-effectiveness of Treatment for Chronic Hepatitis C Infection in an Evolving Patient Population
Joshua A. Salomon, PhD;
Milton C. Weinstein, PhD;
James K. Hammitt, PhD;
Sue J. Goldie, MD, MPH
JAMA. 2003;290:228-237.
Context Approximately 2.7 million US individuals are chronically infected with the hepatitis C virus (HCV). As public health campaigns are pursued, a growing number of treatment candidates are likely to have minimal evidence of liver damage.
Objective To examine the clinical benefits and cost-effectiveness of newer treatments for chronic hepatitis C infection in a population of asymptomatic, HCV sero-positive but otherwise healthy individuals.
Design and Setting Cost-effectiveness analysis using a Markov model of the natural history of HCV infection and impact of treatment. We used an epidemiologic model to derive a range of natural history parameters that were empirically calibrated to provide a good fit to observed data on both prevalence of HCV seropositivity and time trends in outcomes related to HCV infection.
Patients Cohorts of 40-year-old men and women with elevated levels of alanine aminotransferase, positive results on quantitative HCV RNA assays and serologic tests for antibody to HCV, and no histological evidence of fibrosis on liver biopsy.
Interventions Monotherapy with standard or pegylated interferon alfa-2b; combination therapy with standard or pegylated interferon plus ribavirin.
Main Outcome Measures Lifetime costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
Results The probability of patients with chronic HCV developing cirrhosis over a 30-year period ranged from 13% to 46% for men and from 1% to 29% for women. The incremental cost-effectiveness of combination therapy with pegylated interferon for men ranged from $26 000 to $64 000 per QALY for genotype 1 and from $10 000 to $28 000 per QALY for other genotypes; and for women ranged from $32 000 to $90 000 for genotype 1 and from $12 000 to $42 000 for other genotypes. Because the benefits of treatment were realized largely in the form of improvements in health-related quality of life, rather than prolonged survivorship, cost-effectiveness ratios expressed as dollars per year of life were substantially higher. Results were most sensitive to assumptions about the gains and decrements in health-related quality of life associated with treatment.
Conclusions While newer treatment options for hepatitis C appear to be reasonably cost-effective on average, these results vary widely across different patient subgroups and depend critically on quality-of-life assumptions. As the pool of persons eligible for treatment for HCV infection expands to the more general population, it will be imperative for patients and their physicians to consider these assumptions in making individual-level treatment decisions.
Author Affiliations: Harvard Center for Population and Development Studies, Cambridge, Mass, and Global Programme on Evidence for Health Policy, World Health Organization, Geneva Switzerland (Dr Salomon); Center for Risk Analysis, Harvard School of Public Health, Boston, Mass (Drs Salomon, Weinstein, Hammitt, and Goldie).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED LETTERS
Cost-effectiveness of Treatment for Chronic Hepatitis C Infection
David Bernstein
JAMA. 2003;290(15):1993.
EXTRACT
| FULL TEXT
Cost-effectiveness of Treatment for Chronic Hepatitis C Infection
Gregory J. Dore and Hla-Hla Thein
JAMA. 2003;290(15):1993.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Prolonged Therapy for Hepatitis C with Low-Dose Peginterferon
Koretz et al.
NEJM 2009;360:1151-1153.
FULL TEXT
Cost-Effectiveness of Screening and Vaccinating Asian and Pacific Islander Adults for Hepatitis B
Hutton et al.
ANN INTERN MED 2007;147:460-469.
ABSTRACT
| FULL TEXT
Peginterferon {alpha}-2b and ribavirin therapy in chronic hepatitis C genotype 4: impact of treatment duration and viral kinetics on sustained virological response
Kamal et al.
Gut 2005;54:858-866.
ABSTRACT
| FULL TEXT
Treatment Alternatives for Chronic Hepatitis B Virus Infection: A Cost-Effectiveness Analysis
Kanwal et al.
ANN INTERN MED 2005;142:821-831.
ABSTRACT
| FULL TEXT
Biopsychosocial Predictors of Health-Related Quality of Life in Patients With Chronic Hepatitis C
Hauser et al.
Psychosom. Med. 2004;66:954-958.
ABSTRACT
| FULL TEXT
Taking account of future technology in cost effectiveness analysis
Salomon et al.
BMJ 2004;329:733-736.
FULL TEXT
Cost-effectiveness of Treatment for Chronic Hepatitis C Infection
Bernstein
JAMA 2003;290:1993-1993.
FULL TEXT
Cost-effectiveness of Treatment for Chronic Hepatitis C Infection
Dore and Thein
JAMA 2003;290:1993-1993.
FULL TEXT
|
