Cost-effectiveness of peginterferon alpha-2a and peginterferon alpha-2b combination regimens in genotype-1 naive patients with chronic hepatitis C

Abstract

Background/aims: Pegylated interferons (Peg-IFNs) with ribavirin represent the standard treatment in chronic C viral hepatitis in Romania. Primary aim was to evaluate the cost-effectiveness of Peg-IFN alpha-2a plus ribavirin versus IFN alpha-2b plus ribavirin in genotype-1 patients in Romanian setting. The second end point was to make an indirect comparison of the cost-effectiveness of combination therapy of the two Peg-IFNs.

Methodology: Published clinical data on sustained virological response rates (SVR) and early virological response rates (EVR) from more recent published studies were used for both combination therapies. A Markov model with seven health states was built. The reference patient was a 45-year-old male with chronic non-cirrhotic liver disease due to chronic HCV infection. Time horizon is patient lifetime. Published data on the natural history of hepatitis C, local mortality data, published utilities and local expertise were used for assessment of local procedures, resources used and costs. The perspective is that of the National Health Insurance Agency (NHIA).

Results: The incremental cost of treatment with Peg-IFN alpha-2a plus ribavirin is 19,056 Rol per LY gained and 27,175 Rol per QALY gained. A one-way sensitivity analysis showed that results are sensitive to the discount rate used, but they still are highly cost-effective. The indirect comparison of cost-effectiveness of Peg-IFNs combination therapies over IFN alpha-2b showed superiority of Peg-IFN alpha-2a and ribavirin therapy.

Conclusion: This study demonstrates a higher cost-effectiveness of the current state-of-the art treatment with Peg-IFN alpha-2a with ribavirin over the standard IFN and ribavirin combination. Although a slight superiority of Peg-IFN alpha-2a over Peg-IFN alpha-2b combined regimen was shown in Romanian setting in terms of LYs and QALYs gained, there are no significant differences in cost-effectiveness of the two therapies.