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Rapporto costo-efficacia della terapia peginterferone α-2a + ribavirina in confronto a interferone α-2b + ribavirina in pazienti affetti da epatite cronica di tipo C precedentemente non trattati

Cost-effectiveness of Peginterferon α-2a Plus Ribavirin versus Interferon α-2b Plus Ribavirin as Initial Therapy for Treatment-Naïve Chronic Hepatitis C

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PharmacoEconomics Italian Research Articles

Summary

Introduction

In adults with previously untreated chronic hepatitis C (CHC), the combination of peginterferon α-2a plus ribavirin produces a higher rate of sustained virological response (SVR) than interferon α-2b plus ribavirin, but it is still unproven whether this increase is cost-effective. The objective of this study was to determine if the gain in SVR with peginterferon α-2a plus ribavirin is worth the incremental cost.

Methods

We constructed a Markov model of disease progression in which cohorts of patients received peginterferon α-2a plus ribavirin or interferon α-2b plus ribavirin for 48 weeks (hepatitis C virus [HCV] genotype 1 and non-1 patients with fibrosis) or 24 weeks (genotype non-1 patients without fibrosis), and were followed for their expected lifetimes. The reference patient was a 45-year-old male with CHC without cirrhosis. The SVRs with peginterferon α-2a plus ribavirin, and interferon α-2b plus ribavirin, were 46% and 36% for patients infected with HCV genotype 1, and 76% and 61% for patients infected with HCV non-1 genotypes, respectively. QOL and costs for each health state were based on literature estimates and on Italian treatment patterns. Costs in 2002 euros and benefits were discounted at 3%. Sensitivity analyses on key clinical and economic parameters were performed. The analysis was reported from the perspective of the Italian National Health Service.

Results

In patients infected with HCV genotype 1, peginterferon α-2a plus ribavirin increased life years (LY) by 0.78 years and quality-adjusted life years (QALY) by 0.67 years, compared with interferon α-2b and ribavirin. The incremental cost per LY and QALY gained was €9,433 and € 10,894, respectively. In patients infected with HCV non-1 genotypes, peginterferon ?-2a plus ribavirin increased LY by 1.17 and QALY by 1.01 years, compared with interferon α-2b plus ribavirin. The incremental cost per LY and QALY gained was €3,261 and €3,766, respectively. Using genotype distribution estimates, the weighted average ICER for all genotypes was €6,811 per LY gained and €7,865 per QALY gained.

Conclusion

Our model suggests that peginterferon α-2a plus ribavirin is cost-effective compared with conventional interferon α-2b plus ribavirin for treatment of naïve adults with CHC, regardless of HCV genotype, under a wide range of assumptions regarding treatment effectiveness and costs.

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Authors and Affiliations

  1. University of Washington, Seattle, Washington, USA

    Sean D. Sullivan & K. K. Patel

  2. Università di Palermo, Palermo, Italia

    A. Craxì

  3. Università di Padova, Padova, Italia

    A. Alberti

  4. Roche, Milano, Italia

    G. Giuliani & C. De Carli

  5. Roche, Nutley, New Jersey, USA

    N. Wintfeld, K. K. Patel & J. Green

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  1. Sean D. Sullivan
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  2. A. Craxì
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  3. A. Alberti
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Correspondence to Sean D. Sullivan.

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Sullivan, S.D., Craxì, A., Alberti, A. et al. Rapporto costo-efficacia della terapia peginterferone α-2a + ribavirina in confronto a interferone α-2b + ribavirina in pazienti affetti da epatite cronica di tipo C precedentemente non trattati. Pharmacoeconomics-Ital-Res-Articles 6, 105–114 (2004). https://doi.org/10.1007/BF03320628

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