Treatment with Peginterferon Alfa-2b (PEG-Intron) Plus Ribavirin Is Cost-effective for Hepatitis C Patients with F1 Fibrosis

Although not all patients with histologically mild chronic hepatitis C progress, prior studies suggest that antiviral treatment should be cost-effective, but those studies were based on mild inflammation and involved interferon alone or with ribavirin.

The objective of this study was to determine the cost-effectiveness of peginterferon alfa-2b (PEG-Intron) + ribavirin for histologically mild F1 fibrosis.

Using data from Manns (Lancet 2001), researchers compared no antiviral therapy to peginterferon alfa-2b + >10.6 mg/kg ribavirin. Lifelong clinical and economic outcomes were based on Cox proportional hazard models estimating the likelihood of developing Metavir fibrosis stages F1-F4 over time (using 2313 liver biopsies), and on recent UNOS, SEER and NIH data (Wong, AASLD 2003).

Drug costs applied the 12-week stopping rule. Cost-effectiveness results are presented as incremental cost per discounted (3%) quality-adjusted life year gained.

Cost-effectiveness ratios below $50,000 per discounted quality-adjusted life year gained were considered to be cost-effective.

Results

Observed sustained viral response rates for peginterferon alfa-2b + ribavirin treatment of F1 were 63% overall, 52% for genotype 1 and 91% for genotype 2/3.

Antiviral treatment reduced the 20-year incidence of cirrhosis from 20% to 7.6% overall, to 9.7% for genotype 1 and to 1.8% for genotype 2/3.

Antiviral treatment extended life expectancy by 2.3 years overall, 1.9 years for genotype 1 and 3.4 years for genotype 2/3.

Quality-adjusted life expectancy benefits of treatment were 4.7 years overall, 3.9 years for genotype 1 and 6.8 years for genotype 2/3.

Antiviral treatment reduced the future cost of hepatitis C complications by $27,500 overall, $22,900 for genotype 1 and $40,100 for genotype 2/3.

Compared to no antiviral treatment, cost-effectiveness ratios for treatment were $5100 per discounted quality-adjusted life year gained overall, $9000 per discounted quality-adjusted life year gained for genotype 1 and $400 per discounted quality-adjusted life year gained for genotype 2/3.

The authors conclude, “Weight-based peginterferon alfa-2b + ribavirin should be cost-effective for patients with F1 fibrosis.”

05/21/04

Reference
J B Wong and others. Cost-Effectiveness of Peginterferon α-2b plus Ribavirin Treatment of Chronic Hepatitis C with F1 Fibrosis. Abstract 1215 (poster). Digestive Disease Week 2004. May 15-20, 2004. New Orleans, LA.