Cost effectiveness of interferon α or peginterferon α with ribavirin for histologically mild chronic hepatitis C

Grieve, R
Roberts, J
Wright, M
Sweeting, M
DeAngelis, D
Rosenberg, W
Bassendine, M
Main, J
Thomas, H

¹Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
²Department of Medicine, Imperial College, London, UK
³MRC Biostatistics Unit, Cambridge, UK
⁴Statistics, Modelling and Bioinformatics Department, Health Protection Agency, London, UK, and MRC Biostatistics Unit, Cambridge, UK
⁵Division of Infection Inflammation and Repair, University of Southampton, Southampton, UK
⁶School of Clinical Medical Sciences, The Medical School, Newcastle upon Tyne, UK

Correspondence to: Dr R Grieve Health Services Research Unit, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK; [email protected]

Revised 20 December 2005

Accepted 04 January 2006

This study was funded by the UK NHS R&D National Coordinating Centre for Health Technology Assessment (NCCHTA).

Published online first 24 January 2006

Gut 55(9):p 1332-1338, September 2006.

Background:

For patients with mild chronic hepatitis C the cost effectiveness of antiviral therapy is unknown.

Aims:

To assess whether antiviral therapy (either interferon α or peginterferon α combined with ribavirin) is cost effective at a mild stage compared with waiting and only treating those cases who progress to moderate disease.

Patients:

Cases with mild chronic hepatitis C.

Methods:

A cost effectiveness model which estimates long term costs and outcomes for patients with mild chronic hepatitis C. The model uses effectiveness and cost data from the UK mild hepatitis C randomised controlled trial, combined with estimates of disease progression and cost from observational studies.

Results:

Antiviral treatment at a mild rather than a moderate stage improved outcomes measured by quality adjusted life years (QALYS) gained. The mean cost per QALY gained from antiviral treatment with interferon α-2b and ribavirin, compared with no treatment at a mild stage, was £4535 ($7108) for patients with genotype non-1 and £25 188 ($39 480) for patients with genotype 1. Providing peginterferon α-2b and ribavirin at a mild rather than a moderate stage was also associated with a gain in QALYS; the costs per QALY gained were £7821 ($12 259) for patients with genotype non-1 and £28 409 ($44 528) for patients with genotype 1.

Conclusions:

For patients with chronic hepatitis C, it is generally more cost effective to provide antiviral treatment at a mild rather than a moderate disease stage. For older patients (aged 65 years or over) with genotype 1, antiviral treatment at a mild stage is not cost effective.