Technology assessment of pegylated interferon and conventional interferon in combination with ribavirin for the treatment of genotype 1 chronic hepatitis C

Abstract

Objective: To assess the cost-effectiveness comparing two treatment options for adult patients infected with genotype 1 of chronic hepatitis C, naive, under the perspective of Brazilian National Health System: (1) Interferon alpha and Ribavirin; (2) Peginterferon alpha and Ribavirin. Methods: To estimate the cost-effectiveness of different treatments was constructed a simulation model for chronic hepatitis C progression, consisting of various stages of health related to a Markov chain. A cohort of 1000 patients with elevated levels of alanine aminotransferase without histologic evidence of fibrosis and stratified by sex and age (40 years) was followed by a period of 30 years. Results: Combination therapy of pegylated Interferon with Ribavirin vis-à-vis the conventional interferon, has increased the number of patients considered cured by 36%, reduced the incidence of compensated cirrhosis in 17% and 15% in deaths from liver cancer and other complications associated with disease progression. The incremental cost effectiveness ratio (ICER) was 1,925.78 BRL/QALY and 104,457.72 BRL/QALY for Interferon and Peginterferon, respectively. Conclusions: Treatment with conventional Interferon and Ribavirin was more cost-effective due to lower acquisition cost and, under Brazilian National Health System perspective, represents the most efficient strategy.