Cost-effectiveness of pegylated interferon and ribavirin for patients with chronic hepatitis C treated in routine clinical practice

Grishchenko, M; Grieve, Richard; Sweeting, Michael; Angelis, Daniela De; Thomson, Brian J.; Ryder, Stephen; Irving, William L.

doi:10.1017/s0266462309090229

Cited by 42 publications

(68 citation statements)

References 32 publications

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“…34 Specifically, costs per quality adjusted life year (QALY) when compared with no treatment are generally estimated to fall below cost effectiveness thresholds (e.g., < £30,000 per QALY or < U.S.$50,000 per QALY), although one study found that antiviral treatment may not be cost-effective in patients with genotype 1 who have progressed to cirrhosis. [34][35][36][37] In the present study, HCV-related antiviral therapy costs (e.g., interferon α-2a and α-2b, interferon alphacon a, pegylated interferon α-2a and α-2b, and ribavirin), represented a large component of drug costs for HCV patients without AdvLD or with compensated cirrhosis, with PPPY costs for antiviral therapy of $2,445 and $3,243, respectively. HCV antiviral PPPY costs for HCC and transplant patients were less at $1,599 and $1,653, respectively, which represents a smaller proportion of both overall drug costs and incremental drug costs between HCC and transplant patients and their matched comparison enrollees.…”

Section: ■■ Discussionmentioning

confidence: 99%

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

McAdam‐Marx

McGarry

Hane³

et al. 2011

JMCP

149

126

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• Annual total direct and indirect costs related to infections with the hepatitis C virus (HCV) in the United States were estimated at $5.46 billion in 1997. Davis et al. (2011) estimated that all-cause health care costs for managed care organization (MCO) enrollees with HCV were $20,961 per patient per year (PPPY), of which $6,864 PPPY was HCV-related, from 2002 through 2006.• The burden of illness for HCV is predicted to grow over the next 2 decades, partly due to increased prevalence of advanced liver disease (AdvLD) in the current HCV population. What is already known about this subjectAll-Cause and METHODS: This retrospective, matched cohort study included patients aged at least 18 years and with at least 6 months of continuous enrollment in a large managed care organization (MCO) claims database from July 1, 2001, through March 31, 2010. Patients with a diagnosis of HCV (ICD-9-CM codes 070.54, 070.70) were identified and stratified into those with and without AdvLD, defined as decompensated cirrhosis (ICD-9-CM codes 070. 44, 070.71, 348.3x, 456.0, 456.1, 456.2x, 572.2, 572.3, 572.4, 782.4, 789.59); hepatocellular carcinoma (HCC, ICD-9-CM code 155); or liver transplant (ICD-9-CM codes V42.7, 50.5 or CPT codes 47135, 47136). For patients without AdvLD, the index date was the first HCV diagnosis date observed at least 6 months after the first enrollment date, and at least 6 months of continuous enrollment after the index date were required. HCV patients without AdvLD were stratified into those with and without compensated cirrhosis (ICD-9-CM codes 571.2, 571.5, 571.6). For patients with AdvLD, the index date was the date of the first AdvLD diagnosis observed at least 6 months after the first enrollment date, and at least 1 day of enrollment after the index date was required. Cases were matched in an approximate 1:10 ratio to comparison patients without an HCV diagnosis or AdvLD diagnosis who met all other inclusion criteria based on gender, age, hospital referral region state, pre-index health care costs, alcoholism, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and a modified Charlson Comorbidity Index. For the HCV and comparison patient cohorts, PPPY all-cause costs to the payer were calculated as total allowed charges summed across all patients divided by total patient-days of follow-up for the cohort, multiplied by 365, inflation-normalized to 2009 dollars. Because the calculation of PPPY cost generated a single value for each cohort, bootstrapping was used to generate descriptive statistics. Incremental PPPY costs for HCV patients relative to non-HCV patients were calculated as between-group differences in PPPY costs. T-tests for independent samples were used to compare costs between case and comparison cohorts.RESULTS: A total of 34,597 patients diagnosed with HCV, 78.0% with HCV without AdvLD, 4.4% with compensated cirrhosis, 12.3% with decompensated cirrhosis, 2.8% with HCC, and 2.6% with liver transplant, were matched to 330,435 comparison patients. Mean (SD) age of al...

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Section: ■■ Discussionmentioning

confidence: 99%

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

McAdam‐Marx

McGarry

Hane³

et al. 2011

JMCP

149

126

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“…Initial reports of case series of treatment outcomes showed much lower rates of SVR were achieved compared with clinical trials. However, more recent reports show rates comparable to and exceeding those seen in clinical trials, 67 This appears to be due to the evolution of better pathways of care, offering patient support to adhere to therapy, and more conservative therapy reductions to deal with side effects. The additional costs of these supports need to be factored into the analysis especially of some of these more difficult to treat patient groups, but this is likely to be balanced with much lower dropout rates than were modeled in the analysis.…”

Section: Cost Effectiveness In Real World Settingsmentioning

confidence: 99%

Cost effectiveness and quality of life considerations in the treatment of hepatitis C infection

Jafferbhoy

Gashau

Dillon

2010

CEOR

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Chronic hepatitis C 1 is a common cause of liver disease worldwide. It is a slow and progressive condition which can lead to decompensated cirrhosis and hepatocellular carcinoma. Hepatitis C virus 1 impairs quality of life (QOL) even in the absence of chronic liver disease, but its relative silent nature can lead to a delay in diagnosis. The current standard of care of treatment is pegylated interferon and ribavarin. This achieves a sustained virological response (SVR), which is a cure of infection, in up to 80% of patients depending on viral genotype. The attainment of SVR improves survival, avoids long-term complications, and improves QOL. But treatment is not only expensive; there are issues of tolerability and adverse effects. This has led to a multitude of cost effective analysis and health technology assessment on HCV treatment. This overview discusses the natural history of the virus infection and its effect on the patients' QOL. It focuses on the treatment options available, their efficacy, and cost effectiveness. It reviews the evaluations that suggest combination therapy is cost effective and explores the assumptions and limitations of these studies in real world treatment arenas.

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“…For example, Davis et al (2010) in a rare pan-European study (covering France, Germany, Italy, Spain and the UK) documented "real-world" utilisation and costs of PEG IFN/RBV therapy emphasising that they are costly, and that where the burden of HCV is high, public health systems should consider these costs when considering alternative treatments. However, Grishchenko et al (2009) performed a cost-effectiveness analysis in the UK (using information from the Trent HCV database), and concluded that treatment is generally cost-effective, but that there are variations according to sub-group, with lower cost-effectiveness in older patients and in genotype 1 patients with cirrhosis. 13 They used a Markov decision model to estimate the lifetime cost per quality-adjusted life year (QALY) of antiviral treatment compared with no treatment.…”

Section: Health System Factors Influencing Hcv Treatmentmentioning

confidence: 99%

Hepatitis C: Understanding factors that influence the physicians' treatment decisions

Miani¹,

Manville²,

Burge³

et al. 2016

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Cost-effectiveness of pegylated interferon and ribavirin for patients with chronic hepatitis C treated in routine clinical practice

Cited by 42 publications

References 32 publications

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

Cost effectiveness and quality of life considerations in the treatment of hepatitis C infection

Hepatitis C: Understanding factors that influence the physicians' treatment decisions

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