COST-EFFECTIVENESS STUDY OF TREATMENT IN PATIENTS WITH CHRONIC HEPATITIS-C

Objectives.-Chronic active hepatitis C is an important public health i ssue because of its prevalence, evolution, and overall cost. Treatment by recombinant alpha-interferon is both expensive and exacting and it s effectiveness is limited. We report the results of a cost-effectiven ess analysis of alpha-interferon treatment in patients with chronic ac tive hepatitis C. Methods.-Direct medical costs of caring for patients with chronic active hepatitis C and its complications, based on treat ment of no treatment, were assessed with retrospective data collected from the files of 137 hospital patients. Seventy-seven patients were t reated with alpha-interferon between 1988 and 1994. The overall costs of caring for chronic active hepatitis C (3 millions units three times a week) for 6 months (strategy A), 12 months (strategy B), or 12 mont hs but discontinuing treatment when there was no response (strategy C) , was reported and compared to the respective effectiveness of each. R esults.-With an actualization rate of 5%, the real overall cost of car ing for a chronic active hepatitis C patient was 143 290 FF. Consideri ng the contraindication rate (15%), the treatment acceptance (85%), th e response rate to treatment (50%), and the prolonged response rate (2 5 to 30%), treating patients with strategy A induced a real overall co st of caring to 140 731 FF to avoid 0.11 cases of cirrhosis, to 150 27 7 FF to avoid 0.13 cases of cirrhosis with strategy B, and to 136 947 FF to avoid 0.13 cases of cirrhosis with strategy C. Conclusion.-Alpha -interferon treatment in patients with chronic active hepatitis C prov ides a long-term saving compared to cases which receive no treatment. Strategy C was the most cost-effective, inducing the reduction of both the number of cases of cirrhosis and the cost of care.