Which is the most cost-effective combination therapy strategy using interferon α-2b plus ribavirin for naive patients with chronic hepatitis C?

Objective: To compare the cost effectiveness of different therapeutic strategies C using the combination of interferon and ribavirin in the treatment of patients with chronic hepatitis C. Design and setting: This was a cost-effectiveness analysis from the perspective of the Spanish healthcare system. Methods: Six different therapeutic strategies were compared using a decision-tree analysis and a Markov model. These strategies, using combination therapy for 24 or 48 weeks depending on viral genotype and hepatitis C virus (HCV) RNA, were compared on the basis of incremental cost per additional life year saved (LYS) and additional quality-adjusted life year (QALY) saved. Clinical data were derived from major clinical trials and costs from the Spanish healthcare system. Results: For a base-case patient with chronic hepatitis C, the most effective strategy was combination therapy for 24 weeks for genotype non-1 and for 48 weeks for genotype 1 patients who cleared HCV RNA before week 24. Using this strategy, life expectancy increased by 0.07 to 0.38 years vs other strategies and QALY increased 0.15 to 0.84 vs other strategies. The incremental cost per LYS ranged from cost saving to euros (EUR) 1363, and per QALY from cost saving to EUR610 vs other strategies (2000 values, converted to EUR at the official rate of 1EUR = 166.386 pesetas). The cost per LYS and QALY compared with no therapy was EUR2368 and EUR1060, respectively. This strategy perm its the treatment of more patients with the same budget than those strategies based only on HCV genotyping or HCV RNA testing. Conclusion: Defining the duration of combination therapy for patients with 0 chronic hepatitis C by baseline genotyping and HCV RNA testing at week 24 is the best strategy for standard clinical practice.