Interferon Treatment for Chronic Hepatitis B or C Infection: Costs and Effectiveness

Introduction : With recognition that resources are limited, health care payers and policy makers have increasingly turned toward economic analyses to determine whether particular therapies are an efficient use of economic resources. Both chronic hepatitis B and C infections can progress to cirrhosis or hepatocellular carcinoma over time. Interferon treatment has been shown to eradicate viremia, but only does so in a proportion of treated patients. It has potential side effects, has no proven long-term benefit on complications and is relatively expensive. Objective : To determine the cost-effectiveness of interferon treatment by estimating the lifelong economic and clinical outcomes associated with interferon therapy versus standard care for patients with either chronic hepatitis B or C infection. Methods: Computer cohort Markov model simulation to project the lifelong impact of the loss of hepatitis B or C viremia resulting from interferon on cirrhosis, life expectancy, and costs. The natural history of hepatitis B and C was based on published studies. Efficacy estimates for the loss of viremia were based on meta-analysis of published data. Using a societal perspective, economic estimates were based on cost of care data for patients with hepatitis and from estimates regarding the frequency of health resource utilization provided by expert panels. Results: For 20 year old patients with either hepatitis B e antigen positive chronic hepatitis or histologically mild chronic hepatitis C infection, interferon should be cost saving, extending life and reducing lifetime expenditures and morbidity. Life expectancy should increase by 4.8 to 3.1 years for patients with chronic hepatitis B or C, respectively. Lifetime costs should be reduced on average by $ 6,300 to $ 6,900 for each patient treated with interferon. Conchision : Chronic infection with hepatitis B or C can result in liver failure and death. Although only effective in a proportion of treated patients, interferon for chronic hepatitis appears to be an efficient use of societal resources so that economic reasons should not limit its use.