Evaluating the cost of sustained virologic response in naïve chronic hepatitis C patients treated à la carte.

BACKGROUND: There is a tendency to individualize treatment in chronic hepatitis C patients depending on viral load and rapid clearance of HCV-RNA. AIM: To evaluate the cost (euro, 2006) per sustained virologic response in naïve patients with therapy à la carte compared with standard combination therapy.
METHODS: A decision analysis model was used to compare standard therapy with peginterferon alpha and ribavirin for 24 weeks for genotype (G) 2/3, and 48 weeks for G1 and therapy à la carte with the same drugs but different durations: G1 high viral load for 48 weeks, G1 low viral load with rapid virologic response for 24 weeks, and without rapid virologic response for 48 weeks, and G2/3 with rapid virologic response for 12 weeks, and without rapid virologic response for 24 weeks.
RESULTS: Sustained virologic response was similar in both strategies. The cost per successfully treated patient for standard therapy is 17,812 euros and for therapy à la carte 12,313 euros. Assuming that 13,309 patients with standard therapy and 14,450 patients with therapy à la carte achieve sustained virologic response, therapy à la carte has an overall cost-saving of 59.13 million euros.
CONCLUSION: Therapy à la carte is a cost-saving strategy for chronic hepatitis C infection compared to standard therapy, with lower investment requirement per patient to achieve sustained virologic response.