Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic hepatitis C in Brazil

• Published in: The Brazilian journal of infectious diseases Vol. 13; no. 3; pp. 191 - 199
• Main Authors: Fonseca, Marcelo Cunio Machado, Araújo, Gabriela Tannus Branco de, Araújo, Denizar Vianna
• Format: Journal Article
• Language: English
• Published: Brazil Contexto 01-06-2009; Brazilian Society of Infectious Diseases; Elsevier
• Subjects: Adult; Analysis; Antiviral Agents - administration & dosage; Antiviral Agents - economics; Cost-Benefit Analysis; Drug Therapy, Combination; Economic aspects; effectiveness; Hepatitis C; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; Humans; INFECTIOUS DISEASES; Interferon; Interferon-alpha - administration & dosage; Interferon-alpha - economics; interferons; Markov Chains; Markov processes; Polyethylene Glycols - administration & dosage; Polyethylene Glycols - economics; Quality of Life; Recombinant Proteins; Ribavirin - administration & dosage; Ribavirin - economics; Treatment Outcome; Viral antigens; Brazil; effectiveness; interferons; Hepatitis C; cost-benefit analysis
• ISSN: 1413-8670; 1678-4391; 1678-4391
• DOI: 10.1590/S1413-86702009000300007

The treatment of chronic hepatitis C (CHC) with peginterferon alpha-2b/ribavirin (PegIFN + Rib) produced larger sustained viral response (SVR) compared to the conventional (non-pegylated) interferon/ribavirin (IFN + Rib), but its cost-effectiveness was not assessed in Brazil. We developed a Markov model to mirror the natural disease history and cohorts of patients with hepatitis C virus (HCV), that received PegIFN + Rib or IFN + Rib treatment for 48 or 24 weeks, according to viral genotype and liver histology. The SVRs for the treatments PegIFN + Rib and IFN + Rib were respectively 48% and 34% (genotype 1), and 88% and 80% (genotype non-1). Three Delphi panels were conducted with hepatologists and intensivists, and another one with oncologists. The costs are expressed in 2006 Brazilian Reais (R$) and the benefits were discounted at 3%. In genotype 1 HCV patients, PegIFN + Rib increases the life expectancy (LE) in 0.51 year, and the quality-adjusted life years (QALY) in 0.78, as compared to IFN + Rib. In genotype non-1 HCV patients, PegIFN + Rib increases the LE in 0.29 years and the QALY in 0.44 years, as compared to IFN + Rib. The incremental cost-effectiveness rate, considering all the genotypes, was of R$19,848.34 per QALY. Peginterferon alpha-2b with ribavirin is a cost-effective therapy for the treatment of naïve CHC adult patients compared to the interferon alpha-2b and ribavirin regime, irrespective of the viral genotype.