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Weight-based
PEG-Intron Plus Ribavirin Is Cost-effective for HIV-HCV Coinfected
patients with F2 fibrosis and CD4 >200, but Especially for
Those with CD4 >350
Since the introduction of HAART, hepatitis C (HCV) has emerged
as the leading cause of non-AIDS mortality. HCV treatment
in HIV co-infection may be able to reduce future liver deaths.
The objective of this study was to estimate the cost-effectiveness
of peginterferon alfa -2b (PEG-Intron) + ribavirin for HIV-HCV
co-infected patients with various CD4 levels.
Lifelong clinical and economic outcomes were based on Cox proportional
hazard models estimating the likelihood of developing Metavir
fibrosis stages F1, F2, F3 or F4 over time (using 2313 liver
biopsies), a meta-analysis of fibrosis progression in HIV-HCV
infection, and recent UNOS, SEER and NIH data (Wong, AASLD
2003).
AIDS-related mortality was based on a Weibull proportional
hazards survival model developed from 12,574 HIV-infected
patients starting HAART (Egger Lancet 2002). For 40-year olds
with F2 fibrosis and CD4 200-350 or >350, we compared no
HCV therapy to peginterferon alfa -2b+>10.6 mg/kg ribavirin.
Drug costs included epoetin alfa and filgrastim and the 12-week
stopping rule.
Cost-effectiveness results are presented as incremental cost
per discounted (3%) quality-adjusted life year gained.
Results
HCV therapy should increase life expectancy by 1.1 years and
1.3 quality-adjusted life years for CD4 200-350 and by 3.6
years and 2.8 quality-adjusted life years for CD4>350.
For CD4 200-350, cost-effectiveness ratios were $66,800 for
sustained viral response (SVR)=20%, $51,900 for SVR=35% and
$46,100 for SVR=50%.
For CD4>350, cost-effectiveness ratios were $37,600 for
SVR=20%, $31,400 for SVR=35% and $38,000 for SVR=50%.
For 30-year olds with CD4 200-350, cost-effectiveness ratios
were $72,900 for SVR=20%, $55,500 for SVR=35% and $48,900
for SVR=50%, and for CD4>350, cost-effectiveness ratios
were $44,200 for SVR=20%, $36,700 for SVR=35% and $33,800
for SVR=50%.
If epoetin and filgrastim could be avoided, cost-effectiveness
ratios for 40-year olds with CD4 200-350 were $58,400 for
SVR=20%, $46,000 for SVR=35% and $41,100 for SVR=50%, and
for CD4>350 they were $38,200 for SVR=20%, $32,300 for
SVR=35% and $30,000 for SVR=50%.
Te authors conclude, “Weight-based peginterferon alfa-2b +
ribavirin should be cost-effective for co-infected patients
with F2 fibrosis and CD4>200, but especially for those
with CD4>350.”
05/21/04
Reference
J B Wong and others. Cost-Effectiveness Implications of the
Timing of Peginterferon Alfa-2b plus Ribavirin for Chronic
Hepatitis C in HIV-HCV Co-Infected Patients. Abstract 225
(oral). Digestive Disease Week 2004. May 15-20, 2004. New
Orleans, LA.
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