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Hepatitis C Screening and Treatment versus Liver Transplantation

A Financial Option Appraisal and Commissioning Model for Purchasers

  • Original Research Article
  • Published:
Disease Management and Health Outcomes

Abstract

Objectives: To: (i) calculate the number needed to screen (NNS) and community effectiveness of combination treatment (interferon-α plus ribavirin) compared with its efficacy of 28 to 45%; (ii) compare the cost of opportunistic hepatitis C virus (HCV) screening and combined treatment to prevent 1 high risk patient developing cirrhosis with the cost of liver transplantation; and (iii) put a cash value on how much purchasing authorities should bid in a commissioning round for new HCV treatments.

Design: (i) A financial option appraisal of liver transplantation versus opportunistic HCV screening and treatment; (ii) a financial/commissioning model from a purchasers’s perspective using the latest national and international standards/guidelines and audit reports.

Setting and participants: West Kent Health Authority (963 000 residents and 9 primary care groups). All patients at high risk of HCV presenting to health services in 1998/1999 who had an anti-HCV test.

Results: Using current National Institute of Clinical Excellence (NICE) guidance (combined treatment for moderate to severe liver changes), about 113 479 high risk persons need to be screened and medically treated, costing about 50 947 pounds sterling (£) to prevent 1 patient developing cirrhosis in 10 to 20 years. The community effectiveness therefore is 0.00088%.Thenetpresent value (NPV) of HCV screening and combined treatment is −£32 471 to −£25 407 to prevent 1 patient developing cirrhosis compared with liver transplantation; and the marginal cost to fund current volumes is £54 000. In contrast, if current international standards were used (which advocates combined treatment for mild, moderate and severe liver changes), the NNS is 118 to prevent 1 high risk patient developing cirrhosis; the community effectiveness is 0.847%; the NPV is −£6479 to £584; and the variable cost to fund current volumes is £796 850.

Conclusion: The community effectiveness of combined treatment, at best (i.e. using the international model), is 33 to 53 times less than its efficacy; HCV screening and drug treatment is more expensive than liver transplantation. Furthermore, the international model is a far more technically efficient pathway for delivering HCV care than that recommended by NICE guidance.

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References

  1. Younossi ZM. Economic and quality of life measures in the study of viral hepatitis. Viral Hepat Rev 1999; 5: 101–11

    Google Scholar 

  2. Ramsay ME, Balogun MA, Collins M, et al. Laboratory surveillance of HCV virus infection in England and Wales: 1992 to 1996. Commun Dis Public Health 1998 Jun; 1(2): 89–94

    PubMed  CAS  Google Scholar 

  3. Centers for Disease Control and Prevention. Recommendations for prevention and control of HCV virus infection and HCV-related chronic disease. MMWR Morb Mortal Wkly Rep 1998 Oct 16; 47 (RR-19): 1-39

  4. Consensus Panel. EASL International Consensus Conference on HCV Paris 26–28 February 1999. J Hepatol 1999; 30: 956–61

    Article  Google Scholar 

  5. WHO and Viral Hepatitis Prevention Board. Global surveillance and control of HCV. J Viral Hepat 1999; 6: 35–47

    Article  Google Scholar 

  6. National Institute for Clinical Excellence. Guidance on the use of ribavirin and interferon alpha for hepatitis C. London: NICE, 2000

    Google Scholar 

  7. British Liver Trust. C-positive: funding threat to combination treatment. Br Liver Trust 1999; 11: 1

    Google Scholar 

  8. Department of Health. The NHS plan: a plan for investment, a plan for reform. London: Her Majestys’s Stationery Office, 2000

    Google Scholar 

  9. The Wessex Institute. Combination therapy (ribavirin and IFN alfa) to replace IFN alfa alone for the treatment of patients with moderate HCV. DEC report 1999; 100

  10. Schvarcz R, Yun ZB, Sonnerborg A, et al. Combined treatment with IFN alpha-2b and ribavirin for chronic HCV in patients with a previous non-response or non-sustained response to IFN alone. J Med Virol 1995; 46: 43–7

    Article  PubMed  CAS  Google Scholar 

  11. Schalm SW, Hansen BE, Chemello L, et al. Ribavirin enhances the efficacy but not the adverse effects of IFN in chronic HCV. Meta-analysis of individual patient data from European centers. J Hepatol 1996; 26: 961–6

    Article  Google Scholar 

  12. Poynard T, Marcellin P, Lee SS, et al. Randomised trial of IFN alpha2b plus ribavirin for 48 weeks or for 24 weeks versus IFN alpha2b plus placebo for 48 weeks for treatment of chronic infection with HCV virus. International Hepatitis Interventional Therapy Group. Lancet 1998 Oct 31; 352(9138): 1426–32

    Article  PubMed  CAS  Google Scholar 

  13. Reichard O, Norkrans G, Fryden A, et al. Randomised, doubleblind, placebo-controlled trial of interferon alpha-2b with and without ribavirin for chronic hepatitis C. The Swedish Study Group. Lancet 1998 Jan 10; 351(9096): 83–7

    Article  PubMed  CAS  Google Scholar 

  14. McHutchison JG, Gordon SC, Schiff ER, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis Interventional Therapy Group. N Engl J Med 1998 Nov 19; 339(21): 1485–92

    Article  PubMed  CAS  Google Scholar 

  15. Davis GL, Esteban-Mur R, Rustgi V, et al. Interferon alfa-2b alone or in combination with ribavirin for the treatment of relapse of chronic hepatitis C. International Hepatitis Inter-ventional Therapy Group. N Engl J Med 1998 Nov 19; 339(21): 1493–9

    Article  PubMed  CAS  Google Scholar 

  16. Wong JB, Poynard T, Ling MH, et al. Cost-effectiveness of 24 or 48 weeks of interferon alpha-2b alone or with ribavirin as initial treatment of chronic hepatitis C. International Hepatitis Interventional Therapy Group. Am J Gastroenterol 2000 Jun; 95(6): 1524–30

    PubMed  CAS  Google Scholar 

  17. Wong JB, Davis GL, Pauker SG. Cost effectiveness of ribavirin/interferon alfa-2b after interferon relapse in chronic hepatitis C. Am J Med 2000 Apr 1; 108(5): 366–73

    Article  PubMed  CAS  Google Scholar 

  18. Koff RS. Cost-effectiveness of treatment for chronic hepatitis C. J Hepatol 1999; 31 Suppl. 1: 255–8

    Article  PubMed  Google Scholar 

  19. Younossi ZM, Singer ME, McHutchison JG, et al. Cost effectiveness of interferon alpha2b combined with ribavirin for the treatment of chronic hepatitis C. Hepatology 1999 Nov; 30(5): 1318–24

    Article  PubMed  CAS  Google Scholar 

  20. Gordon FD. Cost-effectiveness of screening patients for hepatitis C. Am J Med 1999 Dec 27; 107 (6B): 36S–40S

    Article  PubMed  CAS  Google Scholar 

  21. Leal P, Stein K, Rosenberg W. What is the cost utility of screening for hepatitis C virus (HCV) in intravenous drug users? J Med Screen 1999; 6(3): 124–31

    PubMed  CAS  Google Scholar 

  22. Rembold CM. Number needed to screen: development of a statistic for disease screening. BMJ 1998; 317: 307–12

    Article  PubMed  CAS  Google Scholar 

  23. Foster GR, Goldin RD, Main J, et al. Management of chronic hepatitis C: clinical audit of biopsy based management algorithm. BMJ 1997; 315: 453–8

    Article  PubMed  CAS  Google Scholar 

  24. Hughes N, Bird G. Assessing clinical effectiveness II. Hepatitis C working for negative rewards?. Maidstone: Mid Kent NHS Trust, 1998

    Google Scholar 

  25. NHS Executive. National schedule of reference costs. Leeds: Department of Health, 2000

    Google Scholar 

  26. Wright J, Williams DRR, Wilkinson J. The development and importance of health needs assessment. BMJ 1998; 316: 1310–3

    Article  PubMed  CAS  Google Scholar 

  27. Office of National Statistics. Statistical bulletin: statistics from the Regional Drug Misuse Databases for six months ending March 1999. London: Department of Health, 1999

    Google Scholar 

  28. Office of National Statistics. Statistical bulletin: Statistics from the Regional Drug Misuse Databases for six months ending September 1999. London: Department of Health, 1999

    Google Scholar 

  29. HSC 1999/127. HIV/AIDS funding 1999/2000. London: Department of Health, 1999

  30. National Institute for Clinical Excellence. First work programme for the National Institute for Clinical Excellence. Ref NICE601. London: NHS Press release issue date 06.08.99

  31. Hope T, Hicks N, Reynolds DJ, et al. Rationing and the health authority. BMJ 1998 Oct 17; 317(7165): 1067–9

    Article  PubMed  CAS  Google Scholar 

  32. Haymarket Publishing Services. Monthly index of medical specialties (MIMS) Dec 1999. London: Haymarket Medical, 1999

    Google Scholar 

  33. British Medical Association, Royal Pharmaceutical Society of Great Britain. British national formulary, Vol 38. London: BMA, RPSGB, 1999

    Google Scholar 

  34. Whynes DK, Walker AR. On approximations in treatment costing. Health Econ 1995; 4: 31–9

    Article  PubMed  CAS  Google Scholar 

  35. Williams R, Wright J. Health needs assessment: epidemiological issues in health needs assessment. BMJ 1998; 316: 1379–82

    Article  PubMed  CAS  Google Scholar 

  36. NHS Executive. Draft guidance commissioning specialised services. London: Department of Health, 1998

    Google Scholar 

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  1. Kingston & Richmond Health Authority, 22 Hollyfield Road, Surbiton, KT5 9AL, England

    Nevil Batra (Public Health Specialist)

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  1. Nevil Batra
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Correspondence to Nevil Batra.

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Batra, N. Hepatitis C Screening and Treatment versus Liver Transplantation. Dis-Manage-Health-Outcomes 9, 371–384 (2001). https://doi.org/10.2165/00115677-200109070-00003

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