The conclusion of this abstract nicely sums up the
effectiveness of treating everyone with hepatitis C. It is an
effective public health strategy for eliminating hepatitis C and,
importantly, a means to prevent the pain, suffering and death of many,
many people with hepatitis C. – Alan Franciscus
Impact of Interferon Free Regimens on Clinical and Cost Outcomes for Chronic Hepatitis C Genotype 1 Patients.
Younossi ZM, Singer ME, Mir HM, Henry L, Hunt S.
Center for Liver Diseases, Department of Medicine,
Inova Fairfax Hospital, Falls Church VA, USA; Betty & Guy Beatty
Center for Integrated Research, Inova Health System, Falls Church VA,
USA. Electronic address: firstname.lastname@example.org.
2013 Nov 19. pii: S0168-8278(13)00802-7. doi: 10.1016/j.jhep.2013.11.009. [Epub ahead of print]
Hepatitis C (HCV) is a common
cause of chronic liver disease worldwide. Current standard treatment for
genotype-1 patients uses a triple combination of pegylated-interferon
alpha (IFN), ribavirin (RBV) and a direct-acting antiviral agent (DAA)
with 75-80% sustained virologic response (SVR) rates.
Determine cost-effectiveness of staging-guided
versus treat all HCV genotype-1 patients with interferon-based versus
A decision analytic Markov model simulating
patients until death compared four strategies for treating HCV
genotype-1: Triple therapy (IFN, RBV, DAA) with staging-guidance or
treat all and oral IFN-free regimen with staging-guidance or treat all.
Strategies with staging initiated treatment at fibrosis stages F2-F4,
with staging repeated every 5 years until age 70. The reference case
was a treatment-naïve 50-year-old. Analysis was repeated for 50%
increase in cost of oral therapy. Effectiveness was measured in
quality-adjusted life years (QALYs).
Treat all patients with oral IFN-free regimen was
the most cost-effective strategy, with an ICER of $15,709/QALY at
baseline cost of oral therapy. The ICER remained below $50,000/QALY in
sensitivity analyses for baseline and +50% cost of oral therapy
scenarios. The treat all strategy was also the most effective strategy;
associated with the lowest risk of developing advanced liver disease.
Treating all HCV patients with oral IFN-free
regimen reduced the number of patients developing advanced liver
disease and increased life expectancy. Additionally, IFN-free regimen
without staging may be the most cost-effective approach for treating HCV
genotype-1 patients. The efficacy and safety of these regimens must be
confirmed using randomized clinical trials.
Copyright © 2013. Published by Elsevier B.V.