Cost-effectiveness of Treatment for Hepatitis C in an Urban Cohort Co-infected with HIV - 09/08/11
, Joshua A. Salomon, PhD b, Julie C. Servoss, MD, MPH c, David P. Nunes, MD d, Jeffrey H. Samet, MD, MA, MPH e, Kenneth A. Freedberg, MD, MSc f, g, Sue J. Goldie, MD, MPH g
Requests for reprints should be addressed to Nicole G. Campos, MSc, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115.Abstract |
Purpose |
Recent clinical trials have evaluated treatment strategies for chronic infection with hepatitis C virus (HCV) in patients co-infected with human immunodeficiency virus (HIV). Our objective was to use these data to examine the cost-effectiveness of treating HCV in an urban cohort of co-infected patients.
Methods |
A computer-based model, together with available published data, was used to estimate lifetime costs (2004 US dollars), life expectancy, and incremental cost per year of life saved (YLS) associated with 3 treatment strategies: (1) interferon-alfa and ribavirin; (2) pegylated interferon-alfa; and (3) pegylated interferon-alfa and ribavirin. The target population included treatment-eligible patients, based on an actual urban cohort of HIV-HCV co-infected subjects, with a mean age of 44 years, of whom 66% had genotype 1 HCV, 16% had cirrhosis, and 98% had CD4 cell counts >200 cells/mm3.
Results |
Pegylated interferon-alfa and ribavirin was consistently more effective and cost-effective than other treatment strategies, particularly in patients with non-genotype 1 HCV. For patients with CD4 counts between 200 and 500 cells/mm3, survival benefits ranged from 5 to 11 months, and incremental cost-effectiveness ratios were consistently less than $75,000 per YLS for men and women of both genotypes. Due to better treatment efficacy in non-genotype 1 HCV patients, this group experienced greater life expectancy gains and lower incremental cost-effectiveness ratios.
Conclusions |
Combination therapy with pegylated interferon-alfa and ribavirin for HCV in eligible co-infected patients with stable HIV disease provides substantial life-expectancy benefits and appears to be cost-effective. Overcoming barriers to HCV treatment eligibility among urban co-infected patients remains a critical priority.
Le texte complet de cet article est disponible en PDF.Keywords : Hepatitis C virus (HCV), Human immunodeficiency virus (HIV), Cost-effectiveness, Peginterferon-alfa and ribavirin, Clinical guidelines, Treatment eligibility
Plan
| Supported by the National Institute on Alcohol Abuse and Alcoholism R01-AA13216 and the National Institute of Allergy and Infectious Disease K24 AI062476. |
Vol 120 - N° 3
P. 272-279 - mars 2007 Retour au numéro
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