Pretreatment Evaluation of Chronic Hepatitis C

Abstract

Context.-Chronic hepatitis C (CHC) infection affects nearly 4 million people in the United States. Treatment with interferon alfa-2b has been limited by its cost and low likelihood of long-term response. Objective.-To examine the cost-effectiveness of alternative pretreatment management strategies for patients with CHC. Design.-Decision and cost-effectiveness analysis using a Markov model to examine prevalence of genotypes, viral load, and histological characteristics in relation to the sustained response rate with treatment. Data were based on a previously published decision model and a MEDLINE literature search for hepatitis C, biopsy, and liver from 1966 to 1996. Patients.-A hypothetical population of patients with CHC infection and elevated serum alanine aminotransferase level. Interventions.-Combinations of liver biopsy, genotyping, and quantitative viral load determination prior to a single 6-month course of interferon alfa-2b; empirical interferon treatment; and conservative management. Main Outcome Measures.-Proportion of sustained responders, lifetime costs, life expectancy, and quality-adjusted life expectancy. Results.-Strategies involving hepatitis C virus (HCV) RNA testing had marginal cost-effectiveness ratios up to $4400 per discounted quality-adjusted life-year gained but would miss up to 36% of sustained responders. Empirical interferon treatment had a marginal cost-effectiveness ratio of $12 400 per discounted quality-adjusted life-year gained and reached all potential sustained responders. Strategies involving liver biopsy were more expensive and would miss 6% of sustained responders and yield slightly lower life expectancies. Conclusions.-Routine liver biopsy before treatment with interferon increases the cost of managing patients with CHC without improving health outcomes. Using quantitative HCV RNA testing to guide therapy misses some potential sustained responders. Empirical interferon treatment has a marginal cost-effectiveness ratio within the bounds of other commonly accepted therapies and misses none of the sustained responders.

Outcomes Research in Chronic Viral Hepatitis C: Effects of Interferon Therapy

“…These models typically describe the possible outcomes (costs, survival and quality of life) of hepatitis C infection and assess how the outcomes are affected by treatment. A number of researchers have developed such models in order to conduct economic analyses of hepatitis C therapies (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). Treatment for previously untreated patients: There have been several studies of IFN therapy for previously untreated patients with CHC (30-41).…”

“…A few studies have considered the economic consequences of strategies that focus treatment on subsets of patients with CHC (43)(44)(45). These researchers considered selecting patients for treatment based on criteria including viral genotype, viral load and histological characteristics at baseline.…”

Management of Patients With Hepatitis C in a Community Population: Diagnosis, Discussions, and Decisions to Treat

“…4 Other infected persons remain asymptomatic for decades with no evidence of progression and normal or minimally elevated liver function tests. 5,6 Hepatitis C currently accounts for 40% of all chronic liver disease, 20% to 30% of all liver transplantations, and more than 8,000 deaths each year. 3 Management of Patients With Hepatitis C in a Community Population: Diagnosis, Discussions, and Decisions to Treat…”

Cost Burden of Illness for Hepatitis C Patients with Employer-Sponsored Health Insurance

“…[4][5][6][7] HCV may account for 40% of all chronic liver disease, 20-30% of all liver transplants, and 8,000-10,000 deaths annually. [7][8][9] Since 1991, 28,000-36,000 new cases of HCV have been uncovered each year, 7 the majority of which occur in people younger than 50 years of age. 10 Although HCV infection can have serious long-term consequences, its clinical course is generally indolent and often takes years from exposure to the clinical expression of symptoms.…”