Long-term effectiveness and cost-effectiveness of antiviral treatment in hepatitis C

Abstract

We systematically reviewed the evidence for long-term effectiveness and cost-effectiveness of antiviral treatment in patients with chronic hepatitis C. We performed a systematic literature search on the long-term effectiveness and cost-effectiveness of AVT in hepatitis C (1990-March 2007), and included health technology assessment (HTA) reports, systematic reviews, long-term clinical trials, economic studies conducted alongside clinical trials and decision-analytic modelling studies. All costs were converted to 2005euro. Antiviral therapy with peginterferon plus ribavirin in treatment-naïve patients with chronic hepatitis C was the most effective (3.6-4.7 life years gained [LYG]) treatment and was reasonably cost-effective (cost-saving to 84 700euro/quality adjusted life years [QALY]) when compared to interferon plus ribavirin. Some results also suggest cost-effectiveness (below 8400euro/(QALY) of re-treatment in nonresponders/relapsers. Results for patients with persistently normal alanine aminotransferase (ALT) levels or with special co-morbidities (e.g. HIV) or risk profiles were rare. We conclude that antiviral therapy may prolong life, improve long-term health-related quality-of-life and be reasonably cost-effective in treatment-naïve patients with chronic hepatitis C as well as in former relapsers/nonresponders. Further research is needed in patients with specific co-morbidities or risk profiles.

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

“…33 These antiviral therapies, namely interferon or peg-interferon with ribavirin, have been shown to be reasonably cost-effective when used to prevent progression to AdvLD as a single treatment cycle of 24 or 48 weeks. 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.…”

“…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.…”

“…34,38 However, 2 new protease inhibitors, telaprevir and boceprevir, were approved for use in combination with peginterferon/ribavirin in genotype 1 HCV patients in May 9-CM coding appropriately classified patients by the presence of liver disease or HCC. It is therefore possible that some HCV patients were misclassified by stage of liver disease.…”

50 Is Adding HCV Screening to the Antenatal National Screening Program in Amsterdam, the Netherlands Cost-Effective?

“…These findings are partly due to the slow progression of HCV infection to cirrhosis, especially for women [18], and the relatively high costs for patients treated with new protease inhibitors (boceprevir and telaprevir). However, standard of care treatment is estimated in the literature to be cost-effective in treatment-naïve patients [19]. Therefore we also estimated the ICER when standard of care treatment is used (scenarios 2a and 2b) and found a more favourable ICER than when new treatment options are used, but still above the certain cost-effective threshold of J20,000.…”

Thyroid Function Abnormalities in Patients Receiving Anticancer Agents

“…Reduction in viral load is another relevant activity of interferons. In combination with ribavidin, interferon- prolongs survival in patients with hepatitis C [26,27]. Flu-like syndrome, malaise, neuropsychiatric disorders, hematologic and liver toxicity are the most common doselimiting side-effects.…”