Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic hepatitis C in Brazil

Fonseca, Marcelo Cunio Machado; Araújo, Gabriela Tannus Branco de; Araújo, Denizar Vianna

doi:10.1590/s1413-86702009000300007

Cited by 15 publications

(10 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…34 Specifically, costs per quality adjusted life year (QALY) when compared with no treatment are generally estimated to fall below cost effectiveness thresholds (e.g., < £30,000 per QALY or < U.S.$50,000 per QALY), although one study found that antiviral treatment may not be cost-effective in patients with genotype 1 who have progressed to cirrhosis. [34][35][36][37] In the present study, HCV-related antiviral therapy costs (e.g., interferon α-2a and α-2b, interferon alphacon a, pegylated interferon α-2a and α-2b, and ribavirin), represented a large component of drug costs for HCV patients without AdvLD or with compensated cirrhosis, with PPPY costs for antiviral therapy of $2,445 and $3,243, respectively. HCV antiviral PPPY costs for HCC and transplant patients were less at $1,599 and $1,653, respectively, which represents a smaller proportion of both overall drug costs and incremental drug costs between HCC and transplant patients and their matched comparison enrollees.…”

Section: ■■ Discussionmentioning

confidence: 99%

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

McAdam‐Marx

McGarry

Hane³

et al. 2011

JMCP

148

126

View full text Add to dashboard Cite

• Annual total direct and indirect costs related to infections with the hepatitis C virus (HCV) in the United States were estimated at $5.46 billion in 1997. Davis et al. (2011) estimated that all-cause health care costs for managed care organization (MCO) enrollees with HCV were $20,961 per patient per year (PPPY), of which $6,864 PPPY was HCV-related, from 2002 through 2006.• The burden of illness for HCV is predicted to grow over the next 2 decades, partly due to increased prevalence of advanced liver disease (AdvLD) in the current HCV population. What is already known about this subjectAll-Cause and METHODS: This retrospective, matched cohort study included patients aged at least 18 years and with at least 6 months of continuous enrollment in a large managed care organization (MCO) claims database from July 1, 2001, through March 31, 2010. Patients with a diagnosis of HCV (ICD-9-CM codes 070.54, 070.70) were identified and stratified into those with and without AdvLD, defined as decompensated cirrhosis (ICD-9-CM codes 070. 44, 070.71, 348.3x, 456.0, 456.1, 456.2x, 572.2, 572.3, 572.4, 782.4, 789.59); hepatocellular carcinoma (HCC, ICD-9-CM code 155); or liver transplant (ICD-9-CM codes V42.7, 50.5 or CPT codes 47135, 47136). For patients without AdvLD, the index date was the first HCV diagnosis date observed at least 6 months after the first enrollment date, and at least 6 months of continuous enrollment after the index date were required. HCV patients without AdvLD were stratified into those with and without compensated cirrhosis (ICD-9-CM codes 571.2, 571.5, 571.6). For patients with AdvLD, the index date was the date of the first AdvLD diagnosis observed at least 6 months after the first enrollment date, and at least 1 day of enrollment after the index date was required. Cases were matched in an approximate 1:10 ratio to comparison patients without an HCV diagnosis or AdvLD diagnosis who met all other inclusion criteria based on gender, age, hospital referral region state, pre-index health care costs, alcoholism, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and a modified Charlson Comorbidity Index. For the HCV and comparison patient cohorts, PPPY all-cause costs to the payer were calculated as total allowed charges summed across all patients divided by total patient-days of follow-up for the cohort, multiplied by 365, inflation-normalized to 2009 dollars. Because the calculation of PPPY cost generated a single value for each cohort, bootstrapping was used to generate descriptive statistics. Incremental PPPY costs for HCV patients relative to non-HCV patients were calculated as between-group differences in PPPY costs. T-tests for independent samples were used to compare costs between case and comparison cohorts.RESULTS: A total of 34,597 patients diagnosed with HCV, 78.0% with HCV without AdvLD, 4.4% with compensated cirrhosis, 12.3% with decompensated cirrhosis, 2.8% with HCC, and 2.6% with liver transplant, were matched to 330,435 comparison patients. Mean (SD) age of al...

show abstract

Section: ■■ Discussionmentioning

confidence: 99%

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

McAdam‐Marx

McGarry

Hane³

et al. 2011

JMCP

148

126

View full text Add to dashboard Cite

show abstract

“…Fonseca et al 61 developed a Markov model to mirror the natural disease history in cohorts of patients with hepatitis C virus who received peginterferon alpha-2b with ribavirin or interferon alpha-2b and ribavirin treatment for 48 or 24 weeks, according to their viral genotype and liver histology; they concluded that peginterferon alpha-2b with ribavirin is a cost-effective therapy for treating naïve chronic hepatitis C adult patients compared to the interferon alpha-2b and ribavirin regime, regardless of the viral genotype. Santos et al 62 described fulminant hepatic failure in eight adults and children from a public hospital in Rio de Janeiro, Brazil caused by hepatitis B and one case of severe acute hepatitis caused by hepatitis A. Veras et al 63 described the prevalence of chronic hepatitis C virus in the state of Piaui in northeastern Brazil; Zahdi et al 64 examined the costs and benefits of preventing the disease by utilizing the vaccine for hepatitis A in the southern Brazilian state of Parana.…”

Section: Methodsmentioning

confidence: 99%

Metabolic and infectious pathologies in Brazilian medical literature: a review

Rocha-e-Silva¹

2010

Clinics

View full text Add to dashboard Cite

OBJECTIVE: This review of original reports on metabolic and infectious diseases that were recently published in Brazilian journals is designed to inform the readership of CLINICS about their content.METHODS: I conducted a search in PubMed for original research articles (clinical or basic research) recently published (2008)(2009) by Brazilian medical and biological periodicals. Papers on metabolic pathologies were retrieved by searching for appropriate keywords such as metabolic syndrome and obesity. Papers on infectious disease were obtained by entering 15 different keywords for the most commonly occurring pathologies. Review articles, editorials, letters to the editor, and case reports were manually excluded. Selected titles were then categorized into appropriate sub-categories. RESULTS:This search produced a total of 123 articles, which filtered down to 72 articles after eliminating editorials, review articles, letters to the Editor and case reports.

show abstract

“…Estudos avaliaram, no cenário brasileiro, a relação do custo/efetividade das tecnologias disponíveis para o tratamento da hepatite C em indivíduos monoinfectados 14,15,16,17 . Ainda assim, há uma lacuna significativa do custo/efetividade do tratamento de indivíduos coinfectados VHC/ HIV, principalmente à luz das mais atuais diretrizes para o tratamento da coinfecção no âmbito do Sistema Único de Saúde (SUS) 12 .…”

Section: Introductionunclassified

Custo-efetividade da inclusão dos respondedores virológicos lentos no tratamento da hepatite C na presença da coinfecção com o HIV

et al. 2013

View full text Add to dashboard Cite

Evidências recentes demonstram que respondedores virológicos lentos podem se beneficiar com a extensão do tratamento antiviral. O estudo investigou a adoção desse protocolo diante da coinfecção VHC/HIV. O objetivo foi estudar a relação de custo/efetividade da terapêutica com peguinterferon associado à ribavirina em portadores do genótipo 1 do VHC coinfectados com o HIV, comparando-se a inclusão ou não de respondedores virológicos lentos. Simulou-se por meio de um modelo de Markov a progressão da doença hepática em uma coorte hipotética de mil homens, maiores de 40 anos, considerandose a perspectiva do Sistema Único de Saúde (SUS) e horizonte temporal de 30 anos. A extensão do tratamento para respondedores lentos resultou em uma razão incremental de custo efetividade de R$ 44.171/QALY, valor abaixo do limiar de aceitabilidade proposto pela Organização Mundial da Saúde. A análise de sensibilidade não modificou os resultados alcançados. A inclusão de indivíduos coinfectados VHC/HIV respondedores virológicos lentos no protocolo de tratamento apresenta-se como uma estratégia custo-efetiva para o SUS.

show abstract

Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic hepatitis C in Brazil

Cited by 15 publications

References 37 publications

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

Metabolic and infectious pathologies in Brazilian medical literature: a review

Custo-efetividade da inclusão dos respondedores virológicos lentos no tratamento da hepatite C na presença da coinfecção com o HIV

Contact Info

Product

Resources

About