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.