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COST-EFFECTIVENESS OF TREATMENT FOR CHRONIC
HCV IN PATIENTS COINFECTED WITH HIV
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Reported by Jules Levin
http://www.natap.org
from AASLD
Nov 11, 2005, San Francisco
Julie C. Servoss, GI Unit, Massachusetts General Hospital, Boston, MA; Nicole G. Campos, Joshua A. Salomon, Harvard University Initiative for Global
Health, Cambridge, MA; Kenneth A. Freedberg, Massachusetts General Hospital, Boston, MA; Jeffrey H. Samet, Boston Medical Center, Boston, MA; Sue J. Goldie, Harvard University Initiative for Global Health, Cambridge, MA; Raymond T. Chung, GI Unit, Massachusetts General Hospital, Boston, MA
Background/Aim: Antiviral therapy with pegylated interferon-alpha and ribavirin has been recently approved for treatment of hepatitis C virus (HCV) in human immunodeficiency virus (HIV)- coinfected persons. However, in view of more limited efficacy rates in coinfection, the cost-effectiveness of this treatment merits
investigation. We sought to examine the clinical benefits and cost-effectiveness of treatment for chronic HCV infection in patients co-infected with HIV.
Methods: We modified the natural history, HCV treatment efficacy and cost parameters of an existing Markov model of HCV monoinfection to reflect coinfection with HIV and recent randomized clinical trial data. The two treatment strategies examined were 48 weeks of combination therapy with: (A) pegylated interferon- alpha and ribavirin or (B) interferon-alpha and ribavirin. Outcomes included life expectancy and cost-effectiveness in incremental cost per life-year saved.
Results:
Treatment with pegylated interferon-alpha and ribavirin was consistently more effective and cost-effective than interferon-alpha and ribavirin. For a hypothetical cohort of HIV-HCV coinfected patients with CD4 500/mm3, life expectancy gains with pegylated interferon-alpha and ribavirin ranged from 2.9 months (genotype 1 HCV) to 15.5 months (non-genotype 1 HCV). Incremental cost-effectiveness ratios, stratified by genotype and sex, ranged from $139,700 (men) and $131,700 (women) in genotype 1 HCV patients, to $28,500 (men) and $28,700 (women) for non-genotype 1 HCV patients. HCV therapy in patients with more advanced HIV
disease was less cost-effective for all four groups. Because of the overall superior treatment efficacy in those with non-genotype 1 HCV disease, the incremental cost-effectiveness ratios for treatment were consistently less than $40,000 per life-year gained.
Conclusions: Treatment of chronic HCV with pegylated interferon-alpha and ribavirin is most cost-effective in HIV-infected patients with CD4 500/mm3 and in those with non-genotype 1 HCV. Further clinical studies are needed to assess the effects of treatment regimens in patients with different stages of HIV and
liver disease.
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