Long-term effectiveness and cost-effectiveness of antiviral treatment in hepatitis C

Authors

  • G. Sroczynski,

    1. Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems and Health Technology Assessment, UMIT – University of Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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  • E. Esteban,

    1. Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems and Health Technology Assessment, UMIT – University of Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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  • A. Conrads-Frank,

    1. Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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  • R. Schwarzer,

    1. Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems and Health Technology Assessment, UMIT – University of Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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  • N. Mühlberger,

    1. Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems and Health Technology Assessment, UMIT – University of Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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  • D. Wright,

    1. Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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  • S. Zeuzem,

    1. Department of Internal Medicine, Gastroenterology, Hepatology, Pneumology and Endocrinology, Johann Wolfgang Goethe-University, Frankfurt a. M., Germany
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  • U. Siebert

    1. Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems and Health Technology Assessment, UMIT – University of Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
    2. Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
    3. Centre for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
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Uwe Siebert, MD, MPH, MSc, ScD, Professor of Public Health (UMIT), Adjunct Professor of Health Policy and Management (Harvard University), Chair, Department of Public Health, Information Systems and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, A-6060 Hall i.T., Austria. E-mail: public-health@umit.at

Abstract

Summary.  We systematically reviewed the evidence for long-term effectiveness and cost-effectiveness of antiviral treatment in patients with chronic hepatitis C. We performed a systematic literature search on the long-term effectiveness and cost-effectiveness of AVT in hepatitis C (1990–March 2007), and included health technology assessment (HTA) reports, systematic reviews, long-term clinical trials, economic studies conducted alongside clinical trials and decision-analytic modelling studies. All costs were converted to 2005€. Antiviral therapy with peginterferon plus ribavirin in treatment-naïve patients with chronic hepatitis C was the most effective (3.6–4.7 life years gained [LYG]) treatment and was reasonably cost-effective (cost-saving to 84 700€/quality adjusted life years [QALY]) when compared to interferon plus ribavirin. Some results also suggest cost-effectiveness (below 8400€/(QALY) of re-treatment in nonresponders/relapsers. Results for patients with persistently normal alanine aminotransferase (ALT) levels or with special co-morbidities (e.g. HIV) or risk profiles were rare. We conclude that antiviral therapy may prolong life, improve long-term health-related quality-of-life and be reasonably cost-effective in treatment-naïve patients with chronic hepatitis C as well as in former relapsers/nonresponders. Further research is needed in patients with specific co-morbidities or risk profiles.

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