BACKGROUND: Interferon-alpha is effective in only a small number of patients with chronic hepatitis C, although prolonged treatment may increase the response rate. There is concern that the expense of interferon-alpha therapy may not be justified by the low response rates and uncertain long-term benefit. OBJECTIVE: To compare clinical and economic outcomes after 6 months and 12 months of interferon-alpha therapy for chronic hepatitis C. DESIGN: A Markov model depicting the natural progression of chronic hepatitis C. On the basis of this model, a simulated trial compared no therapy with 6 and 12 months of interferon-alpha therapy at standard doses (3 million U three times weekly). PATIENTS: Four age-specific cohorts (30, 40, 50, and 60 years of age) with chronic hepatitis C. MEASUREMENTS: Number of deaths from liver disease, total costs, and cumulative quality-adjusted life-years (QALYs). RESULTS: Six and 12 months of interferon-alpha treatment gained 0.25 QALYs at an incremental cost of $1000 and 0.37 QALYs at an incremental cost of $1900, respectively. Thus, although 6 months of interferon-alpha therapy was less efficacious than 12 months of therapy, it was more cost-effective ($4000 per QALY gained compared with $5000 per QALY gained). Nonetheless, in patients younger than 60 years of age, both 6 and 12 months of therapy compared favorably with other established medical interventions, such as screening mammography and cholesterol reduction programs. Important variables affecting the cost-effectiveness of interferon-alpha treatment included the cost and efficacy of interferon-alpha, the cost of treatment for decompensated cirrhosis, and quality of life in patients with chronic hepatitis C. CONCLUSION: From the standpoint of cost-effectiveness, interferon-alpha therapy for 6 or 12 months may be justified in patients with chronic hepatitis C. The possible exception is patients older than 60 years of age.
BACKGROUND: Interferon-alpha is effective in only a small number of patients with chronic hepatitis C, although prolonged treatment may increase the response rate. There is concern that the expense of interferon-alpha therapy may not be justified by the low response rates and uncertain long-term benefit. OBJECTIVE: To compare clinical and economic outcomes after 6 months and 12 months of interferon-alpha therapy for chronic hepatitis C. DESIGN: A Markov model depicting the natural progression of chronic hepatitis C. On the basis of this model, a simulated trial compared no therapy with 6 and 12 months of interferon-alpha therapy at standard doses (3 million U three times weekly). PATIENTS: Four age-specific cohorts (30, 40, 50, and 60 years of age) with chronic hepatitis C. MEASUREMENTS: Number of deaths from liver disease, total costs, and cumulative quality-adjusted life-years (QALYs). RESULTS: Six and 12 months of interferon-alpha treatment gained 0.25 QALYs at an incremental cost of $1000 and 0.37 QALYs at an incremental cost of $1900, respectively. Thus, although 6 months of interferon-alpha therapy was less efficacious than 12 months of therapy, it was more cost-effective ($4000 per QALY gained compared with $5000 per QALY gained). Nonetheless, in patients younger than 60 years of age, both 6 and 12 months of therapy compared favorably with other established medical interventions, such as screening mammography and cholesterol reduction programs. Important variables affecting the cost-effectiveness of interferon-alpha treatment included the cost and efficacy of interferon-alpha, the cost of treatment for decompensated cirrhosis, and quality of life in patients with chronic hepatitis C. CONCLUSION: From the standpoint of cost-effectiveness, interferon-alpha therapy for 6 or 12 months may be justified in patients with chronic hepatitis C. The possible exception is patients older than 60 years of age.
Authors: Patrick G Northup; Michael M Abecassis; Michael J Englesbe; Jean C Emond; Vanessa D Lee; George J Stukenborg; Lan Tong; Carl L Berg Journal: Liver Transpl Date: 2009-02 Impact factor: 5.799
Authors: Sean D Sullivan; Antonio Craxi; Alfredo Alberti; Giovanni Giuliani; Claudio De Carli; Neil Wintfeld; Kavita K Patel; Jesse Green Journal: Pharmacoeconomics Date: 2004 Impact factor: 4.981
Authors: Elegance T P Lam; Cindy L K Lam; C L Lai; M F Yuen; Daniel Y T Fong; Thomas M K So Journal: Health Qual Life Outcomes Date: 2009-06-05 Impact factor: 3.186