Patients with mild CHC treated with Pegasys plus ribavirin attain higher sustained virological response (SVR) rates than patients with incomplete septa or cirrhosis. This report utilizes these findings to assess the cost-effectiveness of treating patients with mild CHC with Pegasys plus ribavirin.

Data for HCV genotype 1 patients with mild CHC [1] were obtained from two phase III multinational, randomized, controlled trials [2,3]. Mild CHC was defined as a fibrosis score of F0, F1, or F2 using the METAVIR scale.

Treatment of patients with mild CHC with peginterferon alfa-2a (40KD) (180 µg/week) plus ribavirin (1000/1200 mg/day) resulted in an SVR of 56% (95% CI 50-63%) [1].

The life-time disease progression to cirrhosis, hepatocellular carcinoma, and liver transplant in patients who failed to achieve an SVR was based on published data [4].

The impact of EVR at week 12 (86%; 95% CI 80-89%) on the cost of treatment was included in the model. Quality of life weights and resource costs were based on published literature. Costs related to the treatment of adverse events were not included in the analysis. Costs (in US$ 2004) and benefits were discounted at 3%.

Results

• The patient cohort had a mean age of 42 years, and METAVIR scores of F0 (27%), F1 (37%) and F2 (37%).
• Compared with no treatment, in HCV genotype 1 patients with mild CHC, peginterferon alfa-2a (40KD) plus ribavirin increased quality-adjusted life expectancy (QALY) by 1.46 years yielding an incremental cost per QALY gained of $3,513.
• Despite wide variation in model parameters in sensitivity analyses (SVR as low as 50%, 12-week response as low as 80%, time horizon as short as 20 years), the incremental cost-effectiveness ratio did not exceed $27,000 per QALY gained.
• The most influential variables were time horizon and discounting.
  

Based on these findings, the authors conclude, “Compared with no treatment, for adults with mild CHC, peginterferon alfa-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) is a cost-effective treatment strategy in the US setting.”

“The practice of determining the need for antiviral therapy based on histology may need reassessment in view of these findings.”

1. Shiffman et al. Gastroenterology 2005;128(Suppl) Abstr S1568
2. Zeuzem et al. Gastroenterology 2004;127:1724
3. Fried et al. NEJM 2002;347:975
4. Hui et al. J Hepatol 2003;38:511

05/23/06

Reference