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Cost-Effectiveness of 6 and 12 Months of Interferon-α Therapy for Chronic Hepatitis C

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; and John B. Gross Jr., MD
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From the Mayo Clinic, Rochester, Minnesota. Acknowledgment: The authors thank Andrea Gossard, RN, for assessing the quality of life of patients with chronic hepatitis C. Grant Support: In part by grant DK34238 from the National Institutes of Health. Requests for Reprints: John J. Poterucha, MD, Mayo Clinic (W19), 200 First Street SW, Rochester, MN 55905. Current Author Addresses: Drs. Kim, Poterucha, Dickson, and Gross: Division of Gastroenterology and Hepatology (W19), Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(10):866-874. doi:10.7326/0003-4819-127-10-199711150-00002
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Background: 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.

Objective: To compare clinical and economic outcomes after 6 months and 12 months of interferon-α therapy for chronic hepatitis C.

Design: 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).

Patients: Four age-specific cohorts (30, 40, 50, and 60 years of age) with chronic hepatitis C.

Measurements: Number of deaths from liver disease, total costs, and cumulative quality-adjusted life-years (QALYs).

Results: 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.

Conclusion: 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.


Grahic Jump Location
Figure 1.
Disease states in a Markov model describing the natural history of chronic hepatitis C.

In each cycle (each year), patients move from one state to another depending on the transition probabilities. The introduction of interferon-α creates an additional state (“cure”). OLT = orthotopic liver transplantation.

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Grahic Jump Location
Figure 2.
Progression of chronic hepatitis C in a cohort of patients who are initially 40 years of age, as estimated by the Markov model.

The y-axis represents each patient in the simulation cohort, and the x-axis depicts time since 40 years of age. The cohort is followed longitudinally from left to right, starting from chronic hepatitis C. The proportion of patients in the cohort who fall into various subsequent clinical states after a given elapsed time is indicated by the striped segments. Although many patients die of liver-related causes, most patients who are alive at any given time are relatively well (that is, they have chronic hepatitis C and compensated cirrhosis).

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Grahic Jump Location
Figure 3.
Two-way sensitivity analysis showing the effects of changing cost of interferon-α and cost of treatment for decompensated cirrhosis for 12 months of interferon-α therapy.

The cost-effectiveness of interferon-α therapy improves as the cost of interferon-α decreases and as the costs of treating decompensated cirrhosis increase. QALY = quality-adjusted life-year.

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Grahic Jump Location
Figure 4.
Influence of variation in the rate of cure of hepatitis C after interferon-α treatment on the cost-effectiveness of interferon-α.

As expected, the higher the cure rate, the better the cost-effectiveness of interferon-α. The cost-effectiveness rapidly diminished as the cure rate approached zero. Arrows indicate the base-case scenario. QALY = quality-adjusted life-year.

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