Clinical Effectiveness and Cost Effectiveness of Tailoring Chronic Hepatitis C Treatment with Peginterferon Alpha-2b Plus Ribavirin to HCV Genotype and Early Viral Response: A Decision Analysis Based on German Guidelines
Uwe Siebert (Department of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University of Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Institute for Technology Assessment, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA; Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA) Gaby Sroczynski (Department of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University of Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Institute for Technology Assessment, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA) Pamela Aidelsburger (Institute for Health Services Management, University of Duisburg-Essen, Essen, Germany) Siegbert Rossol (Medical Clinic I, Krankenhaus Nordwest, University of Frankfurt, Frankfurt am Main, Germany) Jurgen Wasem (Institute for Health Services Management, University of Duisburg-Essen, Essen, Germany) Michael P. Manns (Department of Gastroenterology and Hepatology, Medical School of Hanover, Hanover, Germany) John G. McHutchison (Scripps Clinic, La Jolla, California, USA) John B. Wong (Division of Clinical Decision Making, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA)
Abstract
Background Recently developed German guidelines for antiviral treatment in patients with chronic hepatitis C recommend basing drug dosage, intended treatment duration and early stopping rules on the genotype of the hepatitis C virus and early viral responses to treatment. Abstract: Objectives To evaluate effectiveness and cost effectiveness of different antiviral treatment strategies including the German guidelines, for chronic hepatitis C. Abstract: Methods A validated lifetime Markov model was used to project life expectancy, QALYs and lifetime costs for the following strategies: (i) no antiviral therapy (NoAVT); (ii) interferon-α-2b plus ribavirin for 48 weeks (IFN + R); (iii) peginterferon-α-2b plus weight-based ribavirin for 48 weeks (PEG + R); (iv) peginterferon-α-2b plus ribavirin according to German guidelines with genotype-dependent treatment duration, dosage and 12-week viral response evaluation (GUIDE). Clinical and resource utilization data were derived from a clinical trial, the published literature and a survey of German hepatologists. Incremental cost-effectiveness ratios (ICERs) were calculated adopting the German societal perspective. Costs (in €, year 2005 values) and health outcomes were discounted at 3% annually. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Abstract: Results Compared with NoAVT, PEG + R increased undiscounted life expectancy by 5.0 life-years (5.2 QALYs) and GUIDE increased undiscounted life expectancy by 4.9 years (5.1 QALYs). Compared with PEG + R, GUIDE saved 13% of hepatitis C virus-related lifetime costs per patient. GUIDE dominated IFN + R. Compared with NoAVT, discounted ICERs were €1500 per QALY for GUIDE and €3200 per QALY for PEG + R. Abstract: Conclusion Administering GUIDE should allow tailoring treatment efficiently to genotype, bodyweight and early viral response in patients with chronic hepatitis C, and appears cost effective compared with other well accepted medical interventions.
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