A pragmatic and cost-effective strategy of a combination therapy of interferon alpha-2b and ribavirin for the treatment of chronic hepatitis C

Background Combination of interferon (IFN) alpha and ribavirin is considere d the standard treatment for patients with chronic hepatitis C. While combi nation therapy is more effective than IFN alone, the optimal management of combination treatment remains uncertain. Objective To assess a pragmatic and cost-effective strategy for the therapy of treatment-naive patients with chronic hepatitis C. Design Markov model on original data of two randomized trials. Methods A validated computer simulation model was applied to non-cirrhotic hepatitis C virus (HCV)-infected patients. Patient characteristics and effi cacy of treatment were extracted from two randomized trials reporting on 14 45 non-cirrhotic patients. Different strategies were compared separately fo r genotype 1 and genotype non-1 (mostly genotype 2/3) infections: (1) no tr eatment; (2) IFN for 48 weeks (if at 12 weeks HCV RNA undetectable); (3) IF N and ribavirin for 24 weeks; (4) IFN and ribavirin for 48 weeks; (5) IFN a nd ribavirin for 48 weeks (if at 24 weeks HCV RNA undetectable). All strate gies were tested for different combinations of known response factors. comb ination therapy dominates all other strategies. In genotype 1 infection, 48 weeks of combination therapy for week-24 responders only prolongs life exp ectancy at a favourable cost-effectiveness ratio (CE) of 7135 euros per qua lity-adjusted life year (QALY). Taking response factors other than genotype into account does not add to the effectiveness or cost effectiveness. Conclusion Treating non-cirrhotic patients with chronic hepatitis C accordi ng to genotype only is most cost effective independent of the number of oth er known response factors. Eur J Gastroenterol Hepatol 13:483-488 (C) 2001 Lippincott Williams & Wilkins.