W. Ray Kim, MD, MBA; John J. Poterucha, MD; John E. Hermans, BS; Terry M. Therneau, PhD; E. Rolland Dickson, MD; Roger W. Evans, PhD; John B. Gross Jr., MD
Interferon-α is effective in only a small number of patients with chronic hepatitis C, although prolonged treatment may increase the response rate. There is concern that the expense of interferon-α therapy may not be justified by the low response rates and uncertain long-term benefit.
To compare clinical and economic outcomes after 6 months and 12 months of interferon-α therapy for chronic hepatitis C.
A Markov model depicting the natural progression of chronic hepatitis C. On the basis of this model, a simulated trial compared no therapy with 6 and 12 months of interferon-α therapy at standard doses (3 million U three times weekly).
Four age-specific cohorts (30, 40, 50, and 60 years of age) with chronic hepatitis C.
Number of deaths from liver disease, total costs, and cumulative quality-adjusted life-years (QALYs).
Six and 12 months of interferon-α treatment gained 0.25 QALYs at an incremental cost of $1000 and 0.37 QALYs at an incremental cost of $1900, respectively. Thus, although 6 months of interferon-α therapy was less efficacious than 12 months of therapy, it was more cost-effective ($4000 per QALY gained compared with $5000 per QALY gained). Nonetheless, in patients younger than 60 years of age, both 6 and 12 months of therapy compared favorably with other established medical interventions, such as screening mammography and cholesterol reduction programs. Important variables affecting the cost-effectiveness of interferon-α treatment included the cost and efficacy of interferon-α, the cost of treatment for decompensated cirrhosis, and quality of life in patients with chronic hepatitis C.
From the standpoint of cost-effectiveness, interferon-α therapy for 6 or 12 months may be justified in patients with chronic hepatitis C. The possible exception is patients older than 60 years of age.
Kim WR, Poterucha JJ, Hermans JE, Therneau TM, Dickson ER, Evans RW, et al. Cost-Effectiveness of 6 and 12 Months of Interferon-α Therapy for Chronic Hepatitis C. Ann Intern Med. ;127:866–874. doi: 10.7326/0003-4819-127-10-199711150-00002
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Published: Ann Intern Med. 1997;127(10):866-874.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease.
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