A
la Carte Therapy More Cost-effective than Standard Combination Therapy for Treatment-naive
Patients with Chronic Hepatitis C
In
order to tailor the duration of therapy with pegylated interferon plus ribavirin
and to limit side effects and cost, it is important to monitor rapid
virological response (RVR) (undetectable HCV at week 4) and early virological
response (EVR) (undetectable HCV at week 12).
In
the present study, researchers analyzed the financial impact of therapy "a
la carte" (TALC) compared with standard combination therapy (SCT) for a population
of treatment-naive patients infected with genotype 1 (74%) or 2/3 (26%) from the
perspective of the Spanish Health Care System.
A
budgetary impact model was constructed using a decision-tree analysis to compare
the following:
TALC: the same therapy dosages but different duration depending on RVR and HCV
genotype:
- genotype 1 and RVR: 24 weeks of therapy; - genotype 1
and no RVR: 48 weeks; - genotype 2/3 and RVR: 12 weeks; - genotype 2/3
and no RVR: 24 weeks.
SVR
results and costs were assumed based on published studies.
Results
In the base-case scenario (see table, costs in US $), with 100 patients and with
similar SVR rates for both SCT and TALC strategies, TALC would save US $188,001,
corresponding to 16% of the overall costs.
The cost per patient with SVR is lower with TALC, saving US $4,646 per patient
(22% saving).
This saving is even greater among genotype 1 patients.
SCT
TALC
Difference
Overall SVR
54%
58%
– 4%
SVR genotype 1
31%
38%
– 7%
SVR genotype 2/3
23%
20%
3%
Overall Cost (US$)
100 patients
$1,160,624
$972,623
$188,001
74 genotype 1 patients
$939,133
$799,933
$139,200
26 genotype 2/3 patients
$221,491
$172,690
$48,801
Cost/patient with SVR
$21,509
$16,863
$4,646
Genotype 1 patients
$30,217
$21,522
$8,695
Genotype 2/3 patients
$9,681
$8,420
$1,261
Conclusion
Based
on these results, the researchers concluded that:
"RVR is an important predictor of treatment outcome in patients receiving
[PegIntron] plus ribavirin."
"Healthcare costs associated with the treatment of chronic hepatitis C can
be reduced by monitoring RVR to determine treatment duration."
"TALC represents an effective approach for minimizing the healthcare costs
associated with treatment of chronic hepatitis C without compromising SVR rates."
Reference M
Buti, M A Casado, and R Esteban. Therapy A la Carte Is More Cost-Effective than
Standard Combination Therapy for Naive Patients with Chronic Hepatitis C. 57th
AASLD. October 27-31, 2006. Boston, MA. Abstract 359.
SCT: 
