by Alan Franciscus
Cost effectiveness of any therapy is a cornerstone for justifying treatment of a condition. There have been many models that have looked at and found that it is cost effective to treat people with hepatitis C based on the degree of HCV disease progression. A new study is building on the knowledge we already have about the need to treat people with cirrhosis, showing that treatment is cost effective and will limit the future costs associated with decompensation, liver cancer, liver transplantation and death from HCV.
Sammy Saab and colleagues studied the cost-effectiveness of treating people with HCV genotype 1 who had advanced HCV disease progression in order to determine at which point in disease progression treatment becomes cost effective. One thousand patients were enrolled in the study and the study participants evenly divided into 4 groups:
Study Results
Group 1: No treatment
Group 2: Treatment for patients with compensated cirrhosis
Group 3: Treatment for patients with decompensated cirrhosis
Group 4: Treatment for patients with advanced fibrosis after transplantation
Groups 2, 3 and 4 received a 48-week course of pegylated interferon plus ribavirin. Group 1 was the non-treatment group used to compare treatment vs. no treatment. Response for the study participants was defined as sustained virological response (SVR) or no SVR. The measured outcomes of the study included the total cost per patient, the number of quality-adjusted life years (QALYs) saved, cost per QALY saved, number of deaths, number of cases of hepatocellular carcinomas (HCCs) or liver cancer, and the number of transplants required.
All groups that were treated showed some cost savings, but the most cost effective was Group 2 (compensated cirrhosis)—QALYs (0.95) and saved $55,314. Treatment of compensated cirrhosis also resulted in 119 fewer deaths, 54 fewer cases of liver cancer, and 66 fewer transplants. The authors reported that, although not as cost-effective, the treatment of decompensated cirrhosis and even severe recurrence of HCV post-transplant with antiviral therapy was still cost-effective.
The authors concluded that “[T]reatment of patients with compensated cirrhosis was found to be the most cost-effective strategy and resulted in improved survival and decreased cost in comparison with all other strategies
Source: hcvadvocate.org
