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Clinical- and cost-effectiveness of pegylated interferon alfa in the treatment of chronic hepatitis C: A systematic review and economic evaluation

Published online by Cambridge University Press:  02 March 2005

Jonathan Shepherd ,
Håkan F. T. Brodin ,
Carolyn Backer Cave ,
Norman R. Waugh ,
Alison Price  and
John Gabbay
Jonathan Shepherd
Affiliation:
University of Southampton
Håkan F. T. Brodin
Affiliation:
University of Southampton
Carolyn Backer Cave
Affiliation:
University of Southampton
Norman R. Waugh
Affiliation:
University of Aberdeen
Alison Price
Affiliation:
University of Southampton
John Gabbay
Affiliation:
University of Southampton
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Abstract

Objectives: To assess the clinical-effectiveness and cost-effectiveness of pegylated interferon alfa (2a and 2b) combined with ribavirin in previously untreated patients with moderate to severe chronic hepatitis C, compared with the current standard treatment, which is nonpegylated interferon alfa combined with ribavirin.

Methods: Systematic review and economic evaluation. A sensitive search strategy was applied to several electronic bibliographic databases. Relevant studies were critically appraised and meta-analyzed. A hypothetical cohort of 1,000 patients entered a Markov model and were followed up for a more than 30-year period to predict natural history, duration spent in each health state, and treatment costs.

Results: Two fully published Phase III randomized controlled trials were included. Methodological quality was generally good. Dual therapy with pegylated interferon was significantly more effective than nonpegylated dual therapy with a pooled sustained virological response rate (SVR) of 55 percent (95 percent confidence interval [CI], 52–58 percent) compared with 46 percent (95 percent CI, 43–49 percent). The pooled relative risk of remaining infected was 0.83 (95 percent CI, 0.76–0.91 percent). Genotype was the strongest predictor of outcome, with SVRs in patients with the more responsive genotypes 2 and 3 reaching up to 80 percent. The incremental cost per quality-adjusted life year (QALY) for pegylated dual therapy compared with nonpegylated dual therapy was £12,123. The cost per QALY remained under £30,000 for most patient subgroups and in sensitivity analyses.

Conclusions: Pegylated interferon is clinically effective, represents good value for the money, and is a significant advance in the treatment of this insidious disease.

Keywords

Hepatitis CChronicInterferonsMeta-analysisQuality-adjusted life years
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 1 , January 2005 , pp. 47 - 54
Copyright
© 2005 Cambridge University Press

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References

Bennett WG, Inoue Y, Beck JR, et al. 1997 Estimates of the cost-effectiveness of a single course of interferon-alpha 2b in patients with histologically mild chronic hepatitis C. Ann Intern Med. 127: 855– 865.Google Scholar
Buti M, Medina M, Casado MA, et al. 2003 A cost-effectiveness analysis of peginterferon alfa-2b plus ribavirin for the treatment of naive patients with chronic hepatitis C. Aliment Pharmacol Ther. 17: 687– 694.Google Scholar
Davis GL. 2001 Treatment of chronic hepatitis C. BMJ. 323: 1141– 1142.Google Scholar
Davis GL. 2002 Monitoring of viral levels during therapy of hepatitis C. Hepatology. 36: S145– S151.Google Scholar
Davis GL, Esteban MR, Rustgi V, et al. 1998 Interferon alfa-2b alone or in combination with ribavirin for the treatment of relapse of chronic hepatitis C. International Hepatitis Interventional Therapy Group. N Engl J Med. 339: 1493– 1499.Google Scholar
Di Bisceglie AM. 1998 Hepatitis C. Lancet. 351: 351– 355.Google Scholar
Forton DM, Thomas HC, Murphy CA, et al. 2002 Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease. Hepatology. 35: 433– 439.Google Scholar
Fried MW, Shiffman ML, Reddy KR, et al. 2002 Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 347: 975– 982.Google Scholar
Hadziyannis SJ, Sette H, Morgan TR, et al. 2004 Peginterferon-á 2a and ribavirin combination therapy in chronic hepatitis C: A randomized study of treatment duration and ribavirin dose. Ann Intern Med. 140: 346– 355.Google Scholar
Kim WR, Poterucha JJ, Hermans JE, et al. 1997 Cost-effectiveness of 6 and 12 months of interferon-alpha therapy for chronic hepatitis C. Ann Intern Med. 127: 866– 874.Google Scholar
Manns MP, McHutchison JG, Gordon SC, et al. 2001 Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomised trial. Lancet. 358: 958– 965.Google Scholar
Myers RP, Regimbeau C, Thevenot T et al. 2002; Interferon for interferon naive patients with chronic hepatitis C (Cochrane Review). Cochrane Database Syst Rev CD000370.
National Institute for Clinical Excellence. 2000. Guidance on the use of ribavirin and interferon alpha for hepatitis C. London: National Institute for Clinical Excellence;
National Institute for Clinical Excellence (NICE). 2004. Interferon alfa (pegylated and non pegylated) and ribavirin in the treatment of chronic hepatitis C (TA075). London: National Institute for Clinical Excellence;
NHS Centre for Reviews and Dissemination. 2001. Undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews, 2nd ed. York: York Publishing Services Ltd;
Poynard T, Bedossa P, Opolon P. 1997 Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet 349: 825– 832.Google Scholar
Poynard T, McHutchison J, Goodman Z, et al. 2000 Is an “a la carte” combination interferon alfa-2b plus ribavirin regimen possible for the first line treatment in patients with chronic hepatitis C? The ALGOVIRC Project Group. Hepatology. 31: 211– 218.Google Scholar
Shepherd J, Brodin H, Cave C, et al. 2004; Pegylated interferon alpha 2a and 2b in combination with ribavirin in the treatment of chronic hepatitis C: A systematic review and economic evaluation. Health Technol Assess. 8.Google Scholar
Shepherd J, Waugh N, Hewitson P. 2000 Combination therapy (interferon alfa and ribavirin) in the treatment of chronic hepatitis C: A rapid and systematic review. Health Technol Assess. 4.Google Scholar
Siebert U, Sroczynski G, Rossol S, et al. 2003 Cost-effectiveness of peginterferon 2 b plus ribavirin versus interferon 2b plus ribavirin for initial treatment of chronic hepatitis C. Gut. 52: 425– 432.Google Scholar
Thomas HC. 1996: Clinical features of viral hepatitis. In: Weatherall DT, Ledingham J, Warrell DA, eds. Oxford textbook of medicine. 3rd ed. Oxford: Oxford University Press; 2061– 2069.
Verbaan HP, Widell HE, Bondeson TL, Lindgren SC. 2002 High sustained response rate in patients with histologically mild (low grade and stage) chronic hepatitis C infection. A randomized, double blind, placebo controlled trial of interferon alpha-2b with and without ribavirin. Eur J Gastroenterol Hepatol. 14: 627– 633.Google Scholar
Wong JB. 1998 Interferon treatment for chronic hepatitis B or C infection: Costs and effectiveness. Acta Gastroenterol Belg. 61: 238– 242.Google Scholar
Wong JB. 2000 Estimating the cost-effectiveness of ribavirin and pegylated interferon alfa-2B for chronic hepatitis C. Hepatology. 32: 1062.Google Scholar
Wong JB, Bennett WG, Koff RS, Pauker SG. 1998 Pretreatment evaluation of chronic hepatitis C: Risks, benefits, and costs. JAMA. 280: 2088– 2093.Google Scholar