Estimates of the Cost-Effectiveness of a Single Course of Interferon-α2b in Patients with Histologically Mild Chronic Hepatitis C

Bennett, William G.; Inoue, Yoshio; Beck, J. Robert; Wong, John B.; Pauker, Stephen G.; Davis, Gary L.

doi:10.7326/0003-4819-127-10-199711150-00001

Cited by 315 publications

(334 citation statements)

References 0 publications

Supporting

Mentioning

320

Contrasting

Unclassified

Order By: Relevance

“…The use of this model is now well established in the study of chronic disease. [8][9][10] The model followed hypothetical patients over time as they moved among different states of health and determined the likely outcomes. Each state of health was defined by clinical descriptors (written in small capitals therein, and summarized in Fig.…”

Section: Decision Analytic Modelmentioning

confidence: 99%

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

et al. 2000

View full text Add to dashboard Cite

Two treatments are accepted for patients with solitary hepatocellular carcinoma Յ5 cm in size and with preserved hepatic function: (1) liver resection, which can be performed without delay but has a high recurrence rate, and (2) liver transplantation, which has a better long-term survival, but is not easily available because grafts are scarce. A third possibility is to offer liver resection first and liver transplantation for tumor recurrence or deteriorating liver function (''salvage'' transplantation). We investigated the implications of such a strategy with a Markov-based decision analytic model. Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide, and its incidence is increasing in the western world because of the epidemics of the hepatitis C virus. 1 In patients aged less than 65 years, 2 therapies are currently accepted for early HCC (Յ5 cm): partial hepatectomy (PH) and orthotopic liver transplantation (OLT). 2,3 Although studies comparing the 2 treatments are retrospective and concern patients with disparate tumor characteristics and liver function, 4-6 it is agreed that OLT is preferable to partial hepatectomy in patients with hepatic insufficiency and in patients with more than 1 tumor, in whom the results of liver resection are poor.Patients with single tumors and preserved liver function present a therapeutic dilemma. Partial hepatectomy can cure the tumor immediately, with low mortality. The underlying cirrhosis, however, is responsible for a high recurrence rate, and the patient is exposed to the long-term complications of portal hypertension and hepatocellular failure. 7 OLT, by treating both the tumor and the cirrhosis, offers a better long-term survival. The tumor, however, can outgrow the criteria accepted for transplantation while waiting for donor organs, affecting the ultimate outcome as shown in a previous analysis. 2 For patients with a single resectable HCC, an alternative strategy to either partial hepatectomy or OLT would be to offer resection first and transplantation if the tumor recurs or if the liver function deteriorates (salvage OLT). Before such a strategy can be tested in a prospective controlled trial, the present study examines its implications in terms of patient outcome, graft use, and costs, using a decisional analysis model based on the data available in the literature. PATIENTS AND METHODS Decision Analytic ModelWe investigated the impact of 2 options: (1) primary liver transplantation and (2) partial hepatectomy followed by salvage liver transplantation (Fig. 1A) in patients with compensated cirrhosis and solitary HCC Յ5 cm in diameter, with a Markov simulation (Decision Maker 7

show abstract

Section: Decision Analytic Modelmentioning

confidence: 99%

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

et al. 2000

View full text Add to dashboard Cite

show abstract

“…As the literature suggests that mortality due to uncompensated cirrhosis is different, depending on its presentation, we stratified the uncompensated cirrhosis into different categories: ascytis, hemorrhagic varices, hepatic encephalopathy, and ascytis refractory to treatment [8].…”

Section: Probabilitiesmentioning

confidence: 99%

“…Due to the slow progression of chronic hepatitis C [8], the base case was analyzed for a life-time period.…”

Section: Time Windowmentioning

confidence: 99%

“…Due to the clinical course of the infection, it is improper or even feasible to conduct controlled and randomized clinical trials, to investigate the medical-economic impact that better SVR rates could represent [8].…”

mentioning

confidence: 99%

“…As treatment decisions have to be taken right now, we built an analytic decision model to assess both the long-term 'clinical' and 'cost-effectiveness' results that are currently obtained from the treatment of chronic hepatitis C in Brazil, using for this purpose the best available information, although still imperfect [8].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic hepatitis C in Brazil

Fonseca¹,

Araújo²,

Araújo³

2009

Braz J Infect Dis

View full text Add to dashboard Cite

show abstract

Treatment for Hepatitis C Virus in Human Immunodeficiency Virus–Infected Patients

Kuehne¹,

Bethe²,

Freedberg³

et al. 2002

Arch Intern Med

View full text Add to dashboard Cite

show abstract

Estimates of the Cost-Effectiveness of a Single Course of Interferon-α2b in Patients with Histologically Mild Chronic Hepatitis C

Abstract: On the basis of estimations in this mathematical model of the natural history of chronic hepatitis C, treating mild chronic hepatitis with interferon-alpha 2b should prolong life expectancy at a reasonable marginal cost per year of life gained, particularly in younger patients.

Cited by 315 publications

References 0 publications

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic hepatitis C in Brazil

Treatment for Hepatitis C Virus in Human Immunodeficiency Virus–Infected Patients

Contact Info

Product

Resources

About