Cost effectiveness of interferon ?2b combined with ribavirin for the treatment of chronic hepatitis C

Younossi, Zobair M.; Singer, Mendel E.; McHutchison, John G.; Shermock, Kenneth M.

doi:10.1002/hep.510300518

Cited by 153 publications

(140 citation statements)

References 32 publications

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“…17 Current guidelines do not involve HCV screening for newborns, leading to uninformative data concerning changes in childhood infection rates. This may help explain why hospitalization rates remained flat for children younger than 10 years, whereas simultaneously a 15% average annual increase occurred in HCV hospitalizations among adolescents.…”

Section: Discussionmentioning

confidence: 99%

Trends in health care resource use for hepatitis C virus infection in the United States

et al. 2005

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Chronic hepatitis C virus (HCV) infection affects approximately 3 million people in the UnitedStates and places tremendous demands on the health care system. As many observers have predicted, the disease burden continues to grow as the infected population ages. In this study, we analyzed inpatient data from the Healthcare Cost and Utilization Project, outpatient data from the National Ambulatory Medical Care Survey, and drug data from the Verispan Source Prescription Audit. We examined recent growth in the use of health care resources among HCV patients by age group and found average annual increases of 25% to 30% for hospitalizations, charges, hospital days, and physician visits. Corresponding timetrend coefficients were positive (P < .001). From 1994 to 2001, the HCV burden increased among patients aged 40 to 60 years, reflecting the natural history of disease progression. In sensitivity analysis, HCV outcome growth rates remained significant, unless more than 3 out of 4 cases were initially underreported. Also, patients co-infected with HIV and HCV in 2001 constituted 7.5 times as many hospitalizations and incurred 2.9 times the charges in 1994, relative to all HIV hospitalizations and charges. Our findings highlight the urgency concerning HCV outcomes. In conclusion, as patients continue to age and disease burden progresses, suboptimal decisions regarding HCV treatments will bring increasing opportunity costs for the health care system and society.

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Section: Discussionmentioning

confidence: 99%

Trends in health care resource use for hepatitis C virus infection in the United States

et al. 2005

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“…44 The transition probabilities of liver diseases when patients were judged NR after IFN plus ribavirin therapy were 16.2% (3.0%-17.5%; 24 weeks) and 14.7% (6.0%-17.5%; 48 weeks). 27 The SVR rates of patients with HCV-1b after IFN plus ribavirin therapy was 23.3%.…”

Section: Resultsmentioning

confidence: 95%

“…[44][45][46][47][48][49] However, these models do not characterize the progression of HCV-1b (F3) alone and patient QOL scores are not measured. [45][46][47][48][49] Further, these models do not incorporate recent data 15,26,27 on the prognosis for NR patients with HCV-1b after IFN monotherapy or combination therapy.…”

Section: Discussionmentioning

confidence: 99%

“…As for IFN plus ribavirin therapy, the data on QOL scores in patients with HCV, 44 the correlation between the efficacy of IFN plus ribavirin therapy and the number of amino acid mutations in ISDR, 14 the transition probabilities of the liver diseases after IFN plus ribavirin therapy in patients with HCV, 27 and the SVR rate in HCV-1a or -1b infection 13,14 are available, although those data are not specifically for patients with HCV-1b (F3). Therefore, those data were used to discuss the applicability of the present decision analysis model in the case of IFN monotherapy to the case of IFN plus ribavirin therapy.…”

Section: The Outcome Data For Ifn Plus Ribavirin Therapymentioning

confidence: 99%

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Management strategies using pharmacogenomics in patients with severe HCV-1b infection: A decision analysis

Moriguchi

Uemura

Kobayashi³

et al. 2002

Hepatology

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The management of interferon (IFN) therapy for histologically severe chronic hepatitis C virus genotype 1b (HCV-1b [F3]) is controversial. A decision analysis using the Markov decision analysis model was performed for 6 disease management strategies by using clinical data from a Japanese teaching hospital and available published data. The results of base case analyses showed that IFN monotherapy was considered favorable for patients aged 40 to 60 years with HCV-1b (F3). For the sensitivity analyses, to support the results of base case analyses, HCV-1b (F3) patient quality-of-life (QOL) score must be 0.5 or greater for those 40 to 50 years old and 0.4 to 0.5 or greater for those 60 years old. When patients with HCV-1b (F3) were judged as nonresponsive (NR) after IFN monotherapy, the transition probabilities of liver diseases at 40, 50, and 60 years of age had to be such that the progression of liver diseases was controlled at an annual rate of 7.51% to 8.82% or lower, 7.77% to 8.27% or lower, and 6.39% to 6.60% or lower, respectively, and the sustained virologic response (SVR) rate for IFN monotherapy must be 3.0% to 5.51% or greater, 5.57% to 5.93% or greater, and 10.6% to 11.21% or greater, respectively. It is likely that IFN monotherapy could be applied to patients with HCV-1b ( H epatitis C virus (HCV) is a major cause of cirrhosis and hepatocellular carcinoma (HCC) worldwide. 1,2 To prevent transition to cirrhosis or HCC, it is necessary to treat HCV. However, interferon (IFN) monotherapy and IFN plus ribavirin therapy (combination therapy) are complex therapies with adverse effects. 1,3 It is known that the therapeutic effect of IFN treatment varies depending on the genotype. Chronic hepatitis C of genotype 1b (HCV-1b) is resistant to IFN and most frequently seen worldwide (37%-80%). 4-8 For example, the sustained virologic response (SVR) rate to IFN monotherapy on HCV-1b is as low as 10% to 25% in Japan and 10% or less in Europe and the United States. 9 Also, it has been known that the therapeutic effect of IFN therapy decreases with the progression of hepatic fibrosis. Indeed, the SVR of patients with histologically severe HCV-1b (hereinafter referred to as ) to IFN monotherapy was 3.3% to 22.5% in 3 reports 10-12 and our clinical study. On the other hand, according to a recent report, the SVR rate of HCV type 1 is significantly improved by combination therapy compared with IFN monotherapy.For example, Schalm et al. reported that the SVR rate was 8% when IFN monotherapy was performed in patients with HCV type 1 without cirrhosis, and the SVR rate was improved to 33% with combination therapy. 13 Particularly, the SVR rate in patients with HCV-1b improved from 13% with IFN monotherapy to 23.3% with

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“…The cost of antiviral treatment included the cost of antiviral drugs, hematologic growth factors, laboratory tests, and clinic visits. [38][39][40][41] Because these costs vary among institutions, a sensitivity analysis over a wide range of drug costs was performed. The cost of dying was estimated in charges and converted using an assumed costcharge ratio of 0.65.…”

Section: Costsmentioning

confidence: 99%

Is it cost-effective to treat recurrent hepatitis C infection in orthotopic liver transplantation patients?

Saab

Han

et al. 2002

Liver Transplantation

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Hepatitis C virus (HCV) recurs in the allograft almost universally after orthotopic liver transplantation (OLT), with a variable course ranging from mild hepatitis to frank cirrhosis. The uncertain prognosis after OLT has lead to widely increased use of antiviral therapy in the post-OLT setting. We compared two scenarios (antiviral therapy versus no antiviral therapy) using a Markov-based decision analytic model to simulate costs and health outcomes for recurrent HCV in three age and sex cohorts of post-OLT patients. Efficacy outcomes included total costs, cases of cirrhosis prevented, cases of death prevented, lifeyears gained, and cost per life-year saved. One-way sensitivity analyses were performed for sustained viral response; annual drug cost, discount rate, compliance, cirrhosis rate, decompensation rate, and cost of dying. Two-way sensitivity analyses were performed to compare effects of (1) changing sustained viral response and antiviral therapy costs, and (2) changing the sustained viral response and cirrhosis rate. The incremental cost-effectiveness ratio for the reference patient cohort of 1,000 men aged 55 years was $29,100 per life-year saved. The model was sensitive to drug costs, cirrhosis rate, and sustained viral response. The two-way sensitivity analysis showed that antiviral therapy remained cost-effective even if drug costs increased, as long as these increases were associated with higher sustained viral responses. The costeffectiveness ratio also was sensitive to age and sex of cohort. The decision to treat HCV after OLT with antiviral therapy usually is based on many considerations. O rthotopic liver transplantation (OLT) is definitive therapy for patients with decompensated liver disease. Whereas the 1-year survival rate in patients with decompensated liver disease is between 50% and 70%, OLT increases survival to almost 90%. 1-4 Hepatitis C virus (HCV) is one of the leading causes of cirrhosis in patients undergoing OLT in the United States. It now accounts for the majority of liver transplantations in the United States. 5 As the population of individuals infected with HCV several decades ago begin to develop liver disease, the number and relative proportion of patients who undergo OLT for HCV is likely to increase further. 6 HCV recurrence is almost universal after OLT.After 5 years, approximately 75% of transplant recipients have recurrent HCV. 7 Recurrence does not appear to affect short-term survival. The 5-year survival rate of patients who undergo OLT for HCV is similar to that of patients who undergo OLT for other causes of decompensated liver disease. 1,[8][9][10] However, HCV recurrence may have an adverse impact on long-term survival after OLT. Between 8% and 31% of patients who undergo OLT for HCV develop cirrhosis in 5 to 7 years. 8,9,[11][12][13][14][15][16] Thus, the clinical impact of HCV may not be seen for almost a decade after OLT. However, a subgroup of individuals who undergo OLT for HCV have an accelerated course and develop decompensation within several months of OLT...

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Cost effectiveness of interferon ?2b combined with ribavirin for the treatment of chronic hepatitis C

Cited by 153 publications

References 32 publications

Trends in health care resource use for hepatitis C virus infection in the United States

Trends in health care resource use for hepatitis C virus infection in the United States

Management strategies using pharmacogenomics in patients with severe HCV-1b infection: A decision analysis

Is it cost-effective to treat recurrent hepatitis C infection in orthotopic liver transplantation patients?

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