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Watchful Waiting with Periodic Liver Biopsy versus Immediate Empirical Therapy for Histologically Mild Chronic Hepatitis C: A Cost-Effectiveness Analysis

John B. Wong, MD; and Raymond S. Koff, MD
[+] Article and Author Information

for the International Hepatitis Interventional Therapy Group


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(9):665-675. doi:10.7326/0003-4819-133-9-200011070-00008
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Background: Not all patients with histologically mild chronic hepatitis C progress to cirrhosis.

Objective: To compare no antiviral treatment, periodic liver biopsy with subsequent antiviral treatment for moderate hepatitis or cirrhosis, and immediate antiviral therapy.

Design: Cost-effectiveness analysis.

Data Sources: Clinical trial data and published studies.

Target Population: Hepatitis C virus–infected patients with histologically mild hepatitis.

Time Horizon: Lifetime.

Perspective: Societal.

Intervention: Immediate combination antiviral treatment or biopsy every 3 years plus combination antiviral therapy for moderate hepatitis or cirrhosis.

Outcome Measures: Life expectancy, quality-adjusted life expectancy, and costs.

Results of Base-Case Analysis: Over 20 years, biopsy every 3 years with treatment of moderate hepatitis would avoid treatment in 50% of the cohort and would result in an 18% likelihood of cirrhosis compared with 16% for immediate treatment and 27% for no antiviral therapy. Immediate antiviral treatment should increase life expectancy by 1.0 quality-adjusted life-year compared with biopsy management. Over an average lifetime, biopsy management would lead to six liver biopsies costing $6200; immediate antiviral treatment would cost $5100 less than biopsy management because of savings related to biopsy and prevention of future hepatitis C–related morbidity. Immediate therapy was cost-effective compared with biopsy management and had a cost-effectiveness ratio of $7000 compared with no antiviral therapy.

Results of Sensitivity Analysis: When age, sex, genotype, and estimates of histologic progression or compliance with follow-up are varied, immediate therapy should result in an increase of at least 0.8 quality-adjusted life-year compared with biopsy management.

Conclusion: For histologically mild chronic hepatitis C, initial combination treatment compared with periodic liver biopsy should reduce the future risk for cirrhosis, prolong life, and be cost-effective.

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Summary for Patients

Watchful Waiting versus Immediate Treatment for Mild Hepatitis C

Copyright ©2004 by the American College of Physicians

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