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To the Editor: In their cost-effectiveness analysis, Dr Salomon and colleagues¹ found that newer treatment options for hepatitis C virus (HCV) infection appear to be reasonably cost-effective. These results, however, varied widely across different patient subgroups and were reflected largely in quality of life rather than increased survival. These conclusions were based on a Markov model in a theoretical cohort of 40-year-old patients with abnormal alanine aminotransferase levels, detectable serum HCV RNA, and a liver biopsy revealing no fibrosis.

This cohort, however, is not representative of the total US population of patients with HCV infection. The majority of patients with HCV infection are either older or younger than 40 years and have some fibrosis detectable on liver biopsy.² Thus, the analysis by Salomon et al may not reflect the outcomes of such patients. Treatment of patients without fibrosis is controversial and the current National Institutes of Health consensus statement regarding . . . [Full Text of this Article]

David Bernstein, MD
Division of Gastroenterology and Hepatology
North Shore University Hospital
Manhasset, NY

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