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Cost-effectiveness of Combination Peginterferon Alfa-2a (Pegasys) and Ribavirin Compared with Interferon Alfa-2b (Intron A) and Ribavirin in HCV Patients
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Sustained virological response (SVR) is the primary objective in the treatment of chronic hepatitis C (CHC). Results from a recent clinical trial of patients with previously untreated CHC demonstrate that the combination of peginterferon alfa-2a and ribavirin produces a greater SVR than interferon alfa-2b and ribavirin combination therapy.
However, the cost-effectiveness of peginterferon alfa-2a plus ribavirin in the US setting has not been investigated.
A Markov model was developed to investigate cost-effectiveness in patients with CHC using genotype to guide treatment duration. SVR and disease progression parameters were derived from the clinical trials and epidemiologic studies.
The impact of treatment on life expectancy and costs were projected for a lifetime. Patients who had an SVR were assumed to remain virus-free for the rest of their lives.
In genotype 1 patients, the SVRs were 46% for peginterferon alfa-2a plus ribavirin and 36% for interferon alfa-2b plus ribavirin.
In genotype 2/3 patients, the SVRs were 76% for peginterferon alfa-2a plus ribavirin and 61% for interferon alfa-2b plus ribavirin.
Quality of life and costs were based on estimates from the literature. All costs were based on published U.S. medical care costs and were adjusted to 2003 U.S. dollars. Costs and benefits beyond the first year were discounted at 3%.
Results
In genotype 1, peginterferon alfa-2a plus ribavirin increases quality-adjusted life expectancy (QALY) by 0.70 yr compared to interferon alfa-2b plus ribavirin, producing a cost-effectiveness ratio of $2,600 per QALY gained.
In genotype 2/3 patients, peginterferon alfa-2a plus ribavirin increases QALY by 1.05 yr in comparison to interferon alfa-2b plus ribavirin.
Peginterferon alfa-2a combination therapy in patients with HCV genotype 2 or 3 is dominant (more effective and cost saving) compared to interferon alfa-2b plus ribavirin.
Results weighted by genotype prevalence (75% genotype 1; 25% genotype 2 or 3) also show that peginterferon alfa-2a plus ribavirin is dominant.
Peginterferon alfa-2a and ribavirin remained cost-effective (below $16,500 per QALY gained) under sensitivity analyses on key clinical and cost parameters.
Conclusion
In conclusion, the authors write, "Peginterferon alfa-2a (Pegasys) in combination with ribavirin with duration of therapy based on genotype, is cost-effective compared with conventional interferon alfa-2b in combination with ribavirin when given to treatment-naive adults with CHC."
09/17/04
Reference
S D Sullivan and others. Cost-effectiveness of combination peginterferon alfa-2a (Pegasys) and ribavirin compared with interferon alfa-2b (Peg-Intron) and ribavirin in patients with chronic hepatitis C. American Journal of Gastroenterology 99(8): 1490-1496. August 2004.
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