Evaluation of the response to initial antiviral therapy in chronic hepatitis C has been recommended to minimize morbidity and costs.
In this study, investigators from the United States examined the economic and clinical effects of evaluating rapid viral response during therapy for chronic hepatitis C.
The team applied viral response and drug dosage data from a previous clinical trial of ribavirin plus peginterferon alfa-2b, and ribavirin plus interferon alfa-2b, to a computer cohort simulation.
They based natural history and economic estimates on published literature, expert panel estimates, and actual variable and reimbursement cost data.
The investigators found that testing for 12-week rapid viral response reduced antiviral treatment duration by 40 to 44% and antiviral costs by 44 to 45%, compared to full 48-week dosing.
They also determined that the marginal cost-effectiveness of 12-week peginterferon plus ribavirin versus interferon plus ribavirin was $13,600 to $22,800 compared with $14,600 to $25,000.
In addition, for patients with genotype 1 infection, 12-week testing for peginterferon plus ribavirin was preferred and cost-effective, compared with interferon plus ribavirin.
However, for patients with genotype 2 or 3, 12-week testing yielded similar results to those of 24-week treatment.
Dr John B. Wong's team concluded, "Assessment of 12-week viral response in genotype 1, hepatitis C infected patients should reduce peginterferon plus ribavirin morbidity and costs and improve its cost-effectiveness".
"However, for genotype 2 and 3 hepatitis C infected patients, 12-week testing and 24-week treatment have similar outcomes".
"Decisions regarding continuation of antiviral treatment should also consider the variability in the accuracy of quantitative viral assays as well as patient preferences and other potential benefits of the same treatments".