Cost-effectiveness of hematologic growth factors for anemia occurring during hepatitis C combination therapy


  • Richard A. Del Rio,

    Corresponding author
    1. Division of Gastroenterology and Hepatology, University Hospitals of Cleveland, Cleveland, OH
    • Wearn 247, 11100 Euclid Avenue, Cleveland, OH 44106
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    • fax: 216-844-8011

  • Anthony B. Post,

    1. Division of Gastroenterology and Hepatology, University Hospitals of Cleveland, Cleveland, OH
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  • Mendel E. Singer

    1. Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH
    2. Center for Quality Improvement Research, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
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  • See Editorial on Page 1400

  • Potential conflict of interest: Dr. Post owns stock in Amgen. He is on the speakers' bureau for Schering-Plough, Roche, and Valeant.


In hepatitis C virus (HCV)-infected patients who develop anemia during combination therapy, erythropoietic growth factors maintain higher drug treatment levels compared to ribavirin dose reduction, which may lead to an increase in treatment response rates. This study estimated the cost-effectiveness of growth factor therapy in maintaining anemic HCV-infected patients on target drug levels during combination therapy. A decision analysis using a Markov model was developed with 7 health states: Sustained viral response, chronic HCV, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, and death. Data sources included population-based studies of growth factor therapy, previously published estimates of costs and natural history of hepatitis C, and recent prospective studies. Our reference case was a 45-year-old Caucasian man with HCV infection (genotype 1, 2, or 3) who developed anemia while undergoing combination therapy with ribavirin and pegylated interferon. We compared growth factor injections (darbepoetin alpha or epoetin alpha) during combination therapy with standard ribavirin dose reduction. Compared to a ribavirin dose reduction strategy, the cost of darbepoetin per additional quality-adjusted life-year was $34,793 for genotype 1 and $33,832 for genotypes 2 or 3 versus $60,600 and $64,311 for epoetin. For all genotypes, the results were sensitive to changes in the cure rates of HCV therapy, the utility of chronic HCV, the costs of growth factors, and the age at which therapy is begun. In conclusion, use of erythropoietic growth factors, specifically darbepoetin, for patients with anemia occurring during HCV combination therapy appears to be cost-effective for genotypes 1, 2, or 3. (HEPATOLOGY 2006;44:1598–1606.)