ABSTRACT
OBJECTIVES: This study assesses whether pegylated interferon and ribavirin is cost-effective compared with no antiviral treatment provided in routine clinical practice, for different patient subgroups. METHODS: The cost-effectiveness analysis (CEA) uses a Markov decision model to estimate the lifetime cost per quality-adjusted life-year (QALY) of antiviral treatment compared with no treatment. The model is populated with data on sustained virological responses, costs, and transition probabilities all taken from a large representative sample of UK cases and centers (Trent HCV database). RESULTS: The CEA found that pegylated interferon and ribavirin was cost-effective for most patient subgroups. The CEA found that for patients with genotype non-1, the intervention led to cost reductions and gains of at least 0.5 QALYs. For genotype 1 cases with mild or moderate disease, and younger cirrhotic patients (aged 40 or less), costs per QALY remained below 20,000 pound sterling ($40,000 or 29,000 euro). For genotype 1 cases with cirrhosis aged 50, the mean cost per QALY rose to over 60,000 pound sterling ($120,000 or 87,000 euro). CONCLUSIONS: The study concludes that, based on cost and effectiveness data collected from routine clinical practice, treatment with pegylated interferon and ribavirin is generally cost-effective. The study shows that there are variations according to patient subgroup and for older (aged 50 or over) genotype 1 patients with cirrhosis, antiviral treatment appears less cost-effective.
Subject(s)
Antiviral Agents/economics , Hepatitis C, Chronic/drug therapy , Interferon-alpha/economics , Polyethylene Glycols/economics , Ribavirin/economics , Adult , Antiviral Agents/therapeutic use , Cost-Benefit Analysis , Decision Trees , Drug Therapy, Combination , Female , Health Care Costs , Humans , Interferon alpha-2 , Interferon-alpha/therapeutic use , Male , Markov Chains , Middle Aged , Polyethylene Glycols/therapeutic use , Quality-Adjusted Life Years , Recombinant Proteins , Ribavirin/therapeutic useABSTRACT
The choice of instrument (e.g. EQ-5D vs. SF-6D) can lead to different health-related utility scores, but it is unclear why these differences arise and whether they change cost utility analysis (CUA) results. This paper addresses these issues using a case study where using SF-6D rather EQ-5D led to greater utility gain and a lower cost per QALY for treatment. The paper examines reasons for this difference. This paper finds that an important factor was the inclusion in the SF-6D descriptive system of separate items for "vitality" and "social functioning", not explicitly included in EQ-5D. Further studies are required that examine the impact of the choice of instrument on cost-utility.
