PharmacoEconomics & Outcomes News 410 - 3 May 2003

Which hepatitis C therapy worth itin IFN-α nonresponders?

"Until new effective therapies appear", combinationtherapy with interferon (IFN)-α plus ribavirin for 12months "should be considered a cost-effective option"among patients with chronic hepatitis C who havepreviously not responded to IFN-α alone, sayresearchers based in Spain.

They developed a lifetime decision-analysis model,using data obtained from a recently conducted meta-analysis, to compare the following treatment strategiesfor a hypothetical male patient (aged 42 years) withchronic hepatitis C who had previously not respondedto IFN-α monotherapy:• no treatment• IFN-α monotherapy for 6 months• standard-dose IFN-α plus ribavirin for 6 months• high-dose IFN-α plus ribavirin for 6 months• standard-dose IFN-α plus ribavirin for 12 months.The researchers note that all cost values obtained in

the analysis "fall below the benchmark cost per QALY ofmany well-accepted medical interventions in Spain andother countries".

However, the model showed that combinedstandard-dose IFN-α and ribavirin therapy for 12months would be the recommended strategy, as it wasmore effective than no treatment or high-dose IFN-αplus ribavirin for 6 months, and its incremental cost-effectiveness ratio was below the indicated benchmarkof 30 000 euros per quality-adjusted life-year (QALY)gained [see table].

Table. Cost effectiveness of hep C treatmentstrategies among previous interferon-αnonrespondersStrategy Incremental Incremental Cost per

cost (euros)a QALYsb QALY gainedgained (euros)

No treatmentIFN-α 1601 0.15 10 673monotherapyfor 6 months

Standard-dose 3011 0.79 3812IFN-α +ribavirin for6 months

High-dose 682 0.16 4262IFN-α +ribavirin for6 months

Standard-dose 4120 0.45 9155IFN-α +ribavirin for12 months

a Costs (2001 values) were those related to screening patients fortherapy, diagnostic and laboratory tests, drug acquisition, hospitalisationand monitoring during therapy and follow-up, and were assessed fromthe perspective of the Spanish national healthcare system. Costs andoutcomes were discounted at 3% per annum.b quality-adjusted life-years

San Miguel R, et al. Cost-effectiveness analysis of therapeutic strategies forpatients with chronic hepatitis C previously not responding to interferon.Alimentary Pharmacology and Therapeutics 17: 765-773, 15 Mar2003 800938636

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PharmacoEconomics & Outcomes News 3 May 2003 No. 4101173-5503/10/0410-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved