Several models have been developed in an effort to estimate the cost-effectiveness of both IFN mono therapy and combination IFN/ribavirin therapy for the treatment of patients with hepatitis C. Bennett and associates reported that when using a 5% discount rate, the marginal cost-effectiveness ratio of 6 months of IFN mono therapy in previously untreated patients with mild histologic disease was well within the range of other well-accepted medical interventions. Kim and colleagues, using a 3% discount rate, estimated the marginal cost-effectiveness ratio for 6 months of IFN mono therapy to be $4000 per quality-adjusted life year gained, and $5Q00 per quality-adjusted life year gained for 12 months of IFN mono therapy. Both of these figures are within the range of acceptability to our society, and therefore, therapy is considered cost-effective. This study also found that IFN mono therapy was not cost-effective in patients older than age 60.
Combination therapy with IFN and ribavirin is significantly more expensive than IFN mono therapy. Wong and colleagues evaluated the cost-effectiveness of combination therapy vs IFN mono therapy for treatment duration of 24 and 48 weeks. Both the 24- and 48-week IFN-plus-ribavirin regimens were more cost-effective than 48 weeks of IFN mono therapy. Combination therapy for duration of 24 weeks was found to be more cost-effective in patients with genotype 2 and 3 disease. In all other evaluated parameters, including viral load and underlying histology, combination therapy for a 48- week duration was more cost-effective than the 24-week regimen.
The advent of pegylated IFN has raised questions about its relative cost-effectiveness. This concept is difficult to analyze at present, because pegylated IFN has only just been approved for use in the United States, and therefore, its pricing is unknown. However, assuming that pegylated IFNs significantly improve sustained response rates, cost effectiveness can be estimated in the absence of pricing. Based on this assumption, Wong estimated that if peginterferon-alfa-2b increases the sustained response rate by
10% to 30% and increases relative costs by 10% to 30%, a 48-week course should both prolong life and be cost-effective.
Combination therapy with IFN and ribavirin is significantly more expensive than IFN mono therapy. Wong and colleagues evaluated the cost-effectiveness of combination therapy vs IFN mono therapy for treatment duration of 24 and 48 weeks. Both the 24- and 48-week IFN-plus-ribavirin regimens were more cost-effective than 48 weeks of IFN mono therapy. Combination therapy for duration of 24 weeks was found to be more cost-effective in patients with genotype 2 and 3 disease. In all other evaluated parameters, including viral load and underlying histology, combination therapy for a 48- week duration was more cost-effective than the 24-week regimen.
The advent of pegylated IFN has raised questions about its relative cost-effectiveness. This concept is difficult to analyze at present, because pegylated IFN has only just been approved for use in the United States, and therefore, its pricing is unknown. However, assuming that pegylated IFNs significantly improve sustained response rates, cost effectiveness can be estimated in the absence of pricing. Based on this assumption, Wong estimated that if peginterferon-alfa-2b increases the sustained response rate by
10% to 30% and increases relative costs by 10% to 30%, a 48-week course should both prolong life and be cost-effective.
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