From Jules Levin
These posters were presented at EASL, 40th Meeting of the European Association for the Study of Liver Diseases, April 13-17, Paris, France.
COST-EFFECTIVENESS OF PEGINTERFERON a-2b PLUS RIBAVIRIN FOR CHRONIC HEPATITIS C IN HIV-HCV CO-INFECTED PATIENTS
J.B. Wong1, M. Buti2, M.A. Casado3, L. Fosbrook4, V. Soriano5, R. Esteban2
1 Clinical Decision Making, Tufts-New England Medical Center, Boston, MA, USA
2 Hepatology Department, Hospital Vall d'Hebron, Barcelona, Spain
3 Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
4 Schering-Plough, Madrid, Spain
5 Instituto Carlos III, Madrid, Spain
Background: Since the introduction of highly active anti-retroviral therapy (HAART), hepatitis C (HCV) has emerged as the leading cause of non-AIDS mortality. HCV treatment in HIV co-infection may be able to reduce future liver deaths.
Aim: To estimate the cost-effectiveness of peginterferon a-2b + ribavirin for HIV-HCV co-infected patients with various CD4 levels.
Methods: Lifelong clinical and economic outcomes were based on Cox proportional hazard models estimating the likelihood of developing Metavir fibrosis stages F1, F2, F3 or F4 over time (using 2313 liver biopsies), a meta-analysis of fibrosis progression in HIV-HCV infection, and recent UNOS, SEER and NIH data (Wong, AASLD 2003). AIDS-related mortality was based on a Weibull proportional hazards survival model developed from 12,574 HIV-infected patients starting HAART (Egger, Lancet 2002).
For 40-year olds with F2 fibrosis and CD4 200-350 or >350, we compared no HCV therapy to peginterferon a-2b + ribavirin. Viral response was based on 5 Spanish studies. Drug and disease costs were based previously on published Spanish data updated to current costs (Buti, J Hep 2000) assuming a 12-week stopping rule. Cost-effectiveness results are presented as incremental cost per discounted (3%) quality-adjusted life year gained.
Results: HCV therapy should increase life expectancy by 1.5 years and 1.2 quality-adjusted life years (a 16% increase) for CD4 200-350 and by 4.1 years and 3.2 quality-adjusted life years (a 31% increase) for CD4 > 350.
For sustained viral response = 35.6% (n = 272), cost-effectiveness ratios were €10,400 for CD4 200-350 and €8900 for CD4 > 350.
Varying the sustained viral response over the 95%CI from 29.9% to 41.7% yielded cost-effectiveness ratios of €11,900 - €9300 for CD4 200-350 and €9600 - €8400 for CD4 > 350.
If fibrosis progression rates did not increase with co-infection, cost-effectiveness ratios were €12,500 for CD4 200-350 and €9200 for CD4 > 350. Among 30-year olds, cost-effectiveness ratios were €12,100 for CD4 200-350 and €8700 for CD4 > 350 and, and among 50-year olds, they were €15,200 for CD4 200-350 and €9000 for CD4 > 350.
Conclusion: Peginterferon a-2b + ribavirin should be cost-effective for co-infected patients with F2 fibrosis and CD4 > 200, but especially for those with CD4 > 350 because of their longer life expectancy and hence higher likelihood of developing hepatic complications during their lifetime.
COST-EFFECTIVENESS OF PEGINTERFERON a-2a (40 kDa) PLUS RIBAVIRIN IN TREATMENT OF CHRONIC HEPATITIS C (CHC) IN HIV-HCV CO-INFECTION
J. Hornberger1,2,3, G. Carosi4, M. Puoti4, R. Bruno5, J. Green6, K.K. Patel6, G. Giuliani7
1 The SPHERE Institute/Acumen, LLC, Burlingame, CA, USA
2 Department of Veterans Affairs, Palo Alto, CA, USA
3 Stanford University School of Medicine, Stanford, CA, USA
4 Clinica di Malattie Infettive e Tropicali, Università di Brescia, A.O. Spedali Civili di Brescia, Brescia, Italy
5 Divisione Malattie Infettive e Tropicali, IRCCS Policlinico San Matteo Pavia, Pavia, Italy
6 Roche, Nutley, NJ, USA
7 Roche, Italy
The recent AIDS Pegasys Ribavirin International Coinfection Trial (APRICOT) demonstrated the efficacy of peginterferon a-2a plus ribavirin (RBV) and interferon a plus ribavirin (IFN/RBV) in patients co-infected with HIV-HCV. The cost-effectiveness of treating CHC with peginterferon a-2a/RBV has not been assessed in this patient population.
Methods: We developed a Markov Model of CHC disease progression in HIV-HCV co-infection to assess the cost-effectiveness of peginterferon a-2a/RBV compared with IFN/RBV.
Estimates of progression rates came from published studies. Treatment effect on sustained virological response (SVR) was based on findings from APRICOT. The analysis was a cohort of patients with mean age 40 years and HIV-HCV co-infection. Mortality from HIV was based on published results of an HIV Swiss Cohort Study. Quality of life and costs for each health state were based on literature estimates and on the Italian health care setting. Costs in 2003 euros and benefits were discounted at 3%. The Italian National Health Service (NHS) perspective was used.
Results: In genotype 1 patients, quality-adjusted life years (QALYs) and costs increase with peginterferon a-2a/RBV relative to IFN/RBV by 0.76 and €7324, respectively. In genotype 2/3 patients, QALYs and costs increase by 1.44 years and €6222, respectively.
In genotype 1 and 2/3 patients, peginterferon a-2a/RBV is cost-effective compared with IFN/RBV (genotype 1, €9684 per QALY gained; genotype 2/3 €4320 per QALY gained).
Conclusions: Based on our model, peginterferon a-2a/RBV is predicted to increase overall survival, and has cost-effectiveness ratios against IFN/RBV that are within acceptable ranges adopted by the NHS.
