Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T22:33:33.427Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness of pegylated interferon and ribavirin for patients with chronic hepatitis C treated in routine clinical practice

Published online by Cambridge University Press:  31 March 2009

Marina Grishchenko ,
Richard D. Grieve ,
Michael J. Sweeting ,
Daniela De Angelis ,
Brian J. Thomson ,
Stephen D. Ryder  and
William L. Irving
Marina Grishchenko
Affiliation:
H. Lundbeck A/S
Richard D. Grieve
Affiliation:
London School of Hygiene & Tropical Medicine
Michael J. Sweeting
Affiliation:
Medical Research Council
Daniela De Angelis
Affiliation:
Medical Research Council
Brian J. Thomson
Affiliation:
Nottingham University Hospitals
Stephen D. Ryder
Affiliation:
Nottingham University Hospitals
William L. Irving
Affiliation:
Department of Microbiology and Infectious Diseases, University of Nottingham
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: This study assesses whether pegylated interferon and ribavirin is cost-effective compared with no antiviral treatment provided in routine clinical practice, for different patient subgroups.

Methods: The cost-effectiveness analysis (CEA) uses a Markov decision model to estimate the lifetime cost per quality-adjusted life-year (QALY) of antiviral treatment compared with no treatment. The model is populated with data on sustained virological responses, costs, and transition probabilities all taken from a large representative sample of UK cases and centers (Trent HCV database).

Results: The CEA found that pegylated interferon and ribavirin was cost-effective for most patient subgroups. The CEA found that for patients with genotype non-1, the intervention led to cost reductions and gains of at least 0.5 QALYs. For genotype 1 cases with mild or moderate disease, and younger cirrhotic patients (aged 40 or less), costs per QALY remained below £20,000 ($40,000 or €29,000). For genotype 1 cases with cirrhosis aged 50, the mean cost per QALY rose to over £60,000 ($120,000 or €87,000).

Conclusions: The study concludes that, based on cost and effectiveness data collected from routine clinical practice, treatment with pegylated interferon and ribavirin is generally cost-effective. The study shows that there are variations according to patient subgroup and for older (aged 50 or over) genotype 1 patients with cirrhosis, antiviral treatment appears less cost-effective.

Keywords

Chronic hepatitis CDecision-analytic modelRoutine dataCost analysisAntiviral therapy
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 2 , April 2009 , pp. 171 - 180
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Global surveillance and control of hepatitis C. Report of a WHO Consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat. 1999;6:35–47.Google Scholar
2. Bank of England. Annual average Spot exchange rate. http://www.bankofengland.co.uk/mfsd/iadb/index.asp?Travel=NIxIRx&levels=1&C=DMD&FullPage=&FullPageHistory=&Nodes=X3790X3791X3873X33940X3801&SectionRequired=I&HideNums=-1&ExtraInfo=true&E3801XBMX3790X3791.x=16&E3801XBMX3790X3791.y=5. London: Bank of England; 2007.Google Scholar
3. Briggs, AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 2000;17:479–500.CrossRefGoogle ScholarPubMed
4. Briggs, AH. Statistical approaches to handling uncertainty in health economic evaluation. Eur J Gastroenterol Hepatol. 2004;16:551–561.CrossRefGoogle ScholarPubMed
5. British Medical Association. British National Formulary (BNF), No. 54. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain; September 2007.Google Scholar
6. Bruno, S, Stroffolini, T, Colombo, M et al. , Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: A retrospective study. Hepatology. 2007;45:579–587.Google Scholar
7. Castelnuovo, E, Thompson-Coon, J, Pitt, M et al. , The cost-effectiveness of testing for hepatitis C in former injecting drug users. Health Technol Assess. 2006;10:iii–iv, ix–xii, 1–93.Google Scholar
8. Curtis, L. Unit costs of health and social care 2007. Canterbury, UK: PSSRU Personal Social Services Research Unit; 2007.Google Scholar
9. Dalgard, O, Bjøro, K, K, Hellum et al. Treatment of chronic hepatitis C in injecting drug users: 5 years' follow-up. Eur Addict Res. 2002;8:45–49.Google Scholar
10. Fattovich, G, Giustina, G, Degos, F et al. , Morbidity and mortality in compensated cirrhosis type C: A retrospective follow-up study of 384 patients. Gastroenterology. 1997;112:463–472.Google Scholar
11. Freeman, AJ, Dore, GJ, Law, MG et al. , Estimating progression to cirrhosis in chronic hepatitis C virus infection. Hepatology. 2001;34 (pt 1):809–816.CrossRefGoogle ScholarPubMed
12. Fried, MW, Shiffman, ML, Reddy, KR et al. , Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002;347:975–982.Google Scholar
13. Grieve, R, Roberts, J, Wright, M et al. , Cost effectiveness of interferon alpha or peginterferon alpha with ribavirin for histologically mild chronic hepatitis C. Gut. 2006;55:1332–1338.CrossRefGoogle ScholarPubMed
14. Hadziyannis, SJ, Sette, H Jr, Morgan, TR et al. , Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: A randomized study of treatment duration and ribavirin dose. Ann Intern Med. 2004;140:346–355.Google Scholar
15. Health Protection Agency. Hepatitis C in England: an update. Annual Report. London: Health Protection Agency; 2006.Google Scholar
16. Longworth, L, Bryan, S. An empirical comparison of EQ-5D and SF-6D in liver transplant patients. Health Econ. 2003;12:1061–1067.Google Scholar
17. Manns, MP, McHutchison, JG, Gordon, SC et al. , Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomised trial. Lancet. 2001;358:958–965.Google Scholar
18. Michielsen, PP, Francque, SM, van Dongen, JL. Viral hepatitis and hepatocellular carcinoma. World J Surg Oncol. 2005;3:27.CrossRefGoogle ScholarPubMed
19. National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf; 2008.Google Scholar
20. National Institute for Health and Clinical Excellence. Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C. London: NICE; 2004.Google Scholar
21. National Institute for Health and Clinical Excellence. Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C. London: NICE; 2006.Google Scholar
22. Nishiguchi, S, Shiomi, S, Nakatani, S et al. , Prevention of hepatocellular carcinoma in patients with chronic active hepatitis C and cirrhosis. Lancet. 2001;357:196–197.Google Scholar
23. Poynard, T, Mathurin, P, Lai, CL et al. , A comparison of fibrosis progression in chronic liver diseases. J Hepatol. 2003;38:257–265.CrossRefGoogle ScholarPubMed
24. Poynard, T, Yuen, MF, Ratziu, V, Lai, CL. Viral hepatitis C. Lancet. 2003;362:2095–2100.Google Scholar
25. Ryder, SD, Irving, WL, Jones, DA, Neal, KR, Underwood, JC. Progression of hepatic fibrosis in patients with hepatitis C: A prospective repeat liver biopsy study. Gut. 2004;53:451–455.Google Scholar
26. Sharma, P, Lok, A. Viral hepatitis and liver transplantation. Semin Liver Dis. 2006;26:285–297.CrossRefGoogle ScholarPubMed
27. Shepherd, J, Jones, J, Hartwell, D et al. , Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: A systematic review and economic evaluation. Health Technol Assess. 2007;11:1–224.Google Scholar
28. Siebert, U, Sroczynski, G. Effectiveness and cost-effectiveness of initial combination therapy with interferon/peginterferon plus ribavirin in patients with chronic hepatitis C in Germany: A health technology assessment commissioned by the German Federal Ministry of Health and Social Security. Int J Technol Assess Health Care. 2005;21:55–65.Google Scholar
29. Sweeting, M, De Angelis, D, Brant, L, Harris, HE, Mann, AG, Ramsay, ME. The burden of hepatitis C in England. J Viral Hepat. 2007;14:570–576.Google Scholar
30. Sweeting, MJ, De Angelis, D, Neal, KR et al. , Estimated progression rates in three United Kingdom hepatitis C cohorts differed according to method of recruitment. J Clin Epidemiol. 2006;59:144–152.CrossRefGoogle ScholarPubMed
31. Tanaka, J, Kumada, H, Ikeda, K et al. , Natural histories of hepatitis C virus infection in men and women simulated by the Markov model. J Med Virol. 2003;70:378–386.Google Scholar
32. Thabut, D, Le Calvez, S, Thibault, V et al. , Hepatitis C in 6,865 patients 65 yr or older: A severe and neglected curable disease? Am J Gastroenterol. 2006;101:1260–1267.Google Scholar
33. Thomson, BJ, Kwong, G, Ratib, S et al. , Response rates to combination therapy for chronic HCV infection in a clinical setting and derivation of probability tables for individual patient management. J Viral Hepat. 2008;15:271–278.CrossRefGoogle Scholar
34. Wong, JB, McQuillan, GM, McHutchison, JG, Poynard, T. Estimating future hepatitis C morbidity, mortality, and costs in the United States. Am J Public Health. 2000;90:1562–1569.Google Scholar
35. Wong, JB, Poynard, T, Ling, MH, Albrecht, JK, Pauker, SG. Cost-effectiveness of 24 or 48 weeks of interferon alpha-2b alone or with ribavirin as initial treatment of chronic hepatitis C. International Hepatitis Interventional Therapy Group. Am J Gastroenterol. 2000;95:1524–1530.Google ScholarPubMed
36. Wright, M, Goldin, R, Fabre, A et al. , Measurement and determinants of the natural history of liver fibrosis in hepatitis C virus infection: A cross sectional and longitudinal study. Gut. 2003;52:574–579.Google Scholar
37. Wright, M, Grieve, R, Roberts, J, Main, J, Thomas, HC. Health benefits of antiviral therapy for mild chronic hepatitis C: Randomised controlled trial and economic evaluation. Health Technol Assess. 2006;10:1-113, iii.CrossRefGoogle ScholarPubMed
38. Zeuzem, S, Diago, M, Gane, E et al. , Peginterferon alfa-2a (40 kilodaltons) and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels. Gastroenterology. 2004;127:1724–1732.Google Scholar
Supplementary material: File

Grishchenko supplementary material

Figures

Download Grishchenko supplementary material(File)
File 28.2 KB