Over 2.5 million people in the United States have chronic hepatitis C virus (HCV) infection.
However, as public health campaigns are pursued, a growing number of treatment candidates are likely to have minimal evidence of liver damage.
In this study, researchers examined the benefits and cost-effectiveness of treatments for chronic hepatitis C infection in asymptomatic, HCV sero-positive, but otherwise healthy individuals.
The team performed a cost-effectiveness analysis using a Markov model of the natural history of HCV infection and impact of treatment.
|Probability of developing cirrhosis over a 30-year period was between 13% and 46% for men, and 1% and 29% for women.|
|Journal of the American Medical Association|
They derived natural history parameters from an epidemiologic model. These were empirically calibrated to provide a good fit to observed data on both prevalence of HCV seropositivity and time trends in outcomes.
The researchers assessed cohorts of 40-year-olds who had elevated levels of alanine aminotransferase, positive HCV RNA assays and serologic tests for antibody to HCV. Subjects had no histological evidence of fibrosis on liver biopsy.
The subjects were treated using either standard or pegylated interferon alfa-2b, or combination therapy with standard or pegylated interferon plus ribavirin.
The team evaluated the lifetime costs of treatment, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
The researchers found that the probability of patients with chronic HCV developing cirrhosis over a 30-year period was between 13% and 46% for men, and 1% and 29% for women.
They determined that the incremental cost-effectiveness of combination therapy with pegylated interferon for men was between $26,000 and $64,000 per QALY for genotype 1, and between $10,000 and $28,000 for other genotypes.
The cost-effectiveness for women was between $32,000 and $90,000 for genotype 1, and between $12,000 and $42,000 for other genotypes.
The research team found that the benefits of treatment were largely improvements in health-related quality of life, rather than prolonged survivorship, meaning that cost-effectiveness ratios expressed as dollars per year of life were substantially higher.
In addition, results were most sensitive to assumptions about the gains and decrements in health-related quality of life associated with treatment.
Dr Joshua Salomon's team concluded, "While newer treatment options for hepatitis C appear to be reasonably cost-effective on average, these results vary widely across different patient subgroups and depend critically on quality-of-life assumptions".
"As the pool of persons eligible for treatment for HCV infection expands to the more general population, it will be imperative for patients and their physicians to consider these assumptions in making individual-level treatment decisions".