Clinical Briefs
By Louis Kuritzky, MD
Cost Effectiveness of RBV/IFN Alfa-2b After Interferon Relapse in Chronic Hepatitis C
Although interferon (ifn) can transiently eliminate virus from the serum in almost half of hepatitis C infected individuals, most relapse, with or without sustained treatment. Fortunately, combining ribavirin (RBV) with interferon (RBV/IFN) is able to produce undetectable virus levels in almost half of patients who relapse after IFN monotherapy. Unfortunately, RBV/IFN costs almost three times as much as IFN alone, calling into question the cost effectiveness of this regimen.
Using short-term clinical trial data to predict short-term events, and a long-term model based upon the natural history of chronic hepatitis C, Wong and colleagues evaluated the cost effectiveness of RBV/IFN vs. IFN alone, including patients who relapse after IFN monotherapy. Estimates below reflect model projections.
RBV/IFN would decrease lifetime major hepatic consequences (e.g., cirrhosis, CA, hepatic failure/death) by up to 20%, thereby reducing lifetime medical costs by almost $5000, and increasing life expectancy by 4.2 quality-adjusted life years. Patients with moderate hepatitis (as compared with mild) would be anticipated to enjoy greater cost efficacy, since they are inherently more likely to suffer progression of disease.
Wong et al conclude that their analysis supports a six-month course of RBV/IFN for patients who have relapsed after IFN monotherapy, both on a cost and mortality reduction basis.
Wong JB, et al. Am J Med 2000;108: 366-373.
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