Cost-effectiveness of combination therapy for naive patients with chronic hepatitis C

Background/Aims: The higher initial cost of combination therapy is a factor which may discourage its use in naive patients with histologically, mild o r moderate chronic hepatitis C. However, chronic hepatitis C is a slowly pr ogressive disease associated with a decrease in life expectancy and quality of life. The objective of this study was to determine if the incremental s ustained response rate of combination therapy is sufficient to outweigh its extra cost. Methods: Chronic hepatitis C progression was studied using a Markov model i n which cohorts of patients were treated with combination therapy for 6-12 months or with interferon for 12 months. The sustained virological response rates applied were 43, 35 and 19%, respectively, for combination therapy f or 12 months, for 6 months and for interferon for 12 months. Costs for each clinical state were calculated according to clinical practice in Spain. Results: In a 30-year-old patient with moderate chronic hepatitis C, combin ation therapy for 12 months increases life expectancy by 4.1 years compared with interferon for 12 months. In mild disease, the increase in life expec tancy is lower. The cost per life-year saved in patients with chronic hepat itis C ranges from 880 to 64.421 euros depending on the age of the patient, the degree of hepatic lesion and the type and duration of therapy. Compare d to other treatments accepted as standard practice in other therapeutic ar eas, combination therapy for chronic hepatitis C is cost-effective. Conclusions: In patients of any age with moderate chronic hepatitis C and t hose with mild disease under 50 years of age, combination therapy for 12 mo nths is the most cost-effective schedule, whereas in older patients with mi ld hepatitis, combination therapy for 6 months is the preferred option base d on cost-effectiveness criteria.