A health economic model to assess the cost-effectiveness of pegylated interferon a-2a and ribavirin in patients with moderate chronic hepatitis C and persistent- ly normal alanine aminotransferase levels

Background and study aims : The treatment of patients with moderate chronic hepatitis C and persistently normal alanine aminotransferase levels is still under discussion and the cost-effec- tiveness of such strategy is unknown. The objective of this study was to estimate the cost-effectiveness of their treatment in com- parison with no treatment. Patients and methods : The assessed treatment is composed of pegylated interferon a-2a and ribavirin, which is the current stan- dard treatment. Two groups were studied : patients with genotype 1 and patients with genotypes 2-3. At the beginning of the study, patients were aged of 45. Long-term economic and clinical outcomes over a 30 year peri- od were predicted using a Markov simulation model. A health care payer perspective was chosen. Data were obtained from published literature. Variations of uncertainty parameters were assessed through a sensitivity analysis. Results : The incremental cost-effectiveness ratios (ICERs) were &euro; 5,338/QALY for genotype 1 and &euro; 1,080/QALY for genotypes 2- 3. In the sensitivity analysis, ratios remained lower than &euro; 20,00O.A Monte Carlo simulation with 1,000 iterations gives a 95% con- fidence interval for the ICER of &euro; 3,199 to &euro; 8,972 for genotype 1 and &euro; 56 to &euro; 1,981 for genotypes 2-3. Conclusion : Even though the treatment of these patients gener- ates a cost, it has the advantage that in comparison with no treat- ment, a great number of people are cured, complications are less frequent and patients gain more quality-adjusted life-year (QALY), which involves an ICER considered as acceptable for the European society (< &euro; 20,000). (Acta gastroenterol. belg., 2007, 70, 177-187).