gms | German Medical Science

49. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
19. Jahrestagung der Schweizerischen Gesellschaft für Medizinische Informatik (SGMI)
Jahrestagung 2004 des Arbeitskreises Medizinische Informatik (ÖAKMI)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Schweizerische Gesellschaft für Medizinische Informatik (SGMI)

26. bis 30.09.2004, Innsbruck/Tirol

Cost-effectiveness of Peginterferon plus Ribavirin in a Real-World Population of Patients with Chronic Hepatitis C and Associated Comorbidities

Meeting Abstract (gmds2004)

  • corresponding author presenting/speaker Uwe Siebert - Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, USA
  • Gaby Sroczynski - Bavarian Public Health Research and Coordinating Center, University of Munich, Munich, Deutschland
  • Siegbert Rossol - Dept. of Internal Medicine, General Hospital Ruesselsheim, University of Mainz, Mainz, Deutschland
  • Pamela Aidelsburger - Alfried Krupp von Bohlen and Halbach Chair for Medical Management, University of Duisburg-Essen, Duisburg-Essen, Deutschland
  • Annette Conrads-Frank - Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, USA
  • John Wong - Tufts-New England Medical Center, Tufts University School of Medicine, Boston, USA
  • Jürgen Wasem - Alfried Krupp von Bohlen and Halbach Chair for Medical Management, University of Duisburg-Essen, Duisburg-Essen, Germany, Deutschland
  • German Hepatitis C Model (GEHMO) Group - Deutschland

Kooperative Versorgung - Vernetzte Forschung - Ubiquitäre Information. 49. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 19. Jahrestagung der Schweizerischen Gesellschaft für Medizinische Informatik (SGMI) und Jahrestagung 2004 des Arbeitskreises Medizinische Informatik (ÖAKMI) der Österreichischen Computer Gesellschaft (OCG) und der Österreichischen Gesellschaft für Biomedizinische Technik (ÖGBMT). Innsbruck, 26.-30.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04gmds118

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2004/04gmds118.shtml

Veröffentlicht: 14. September 2004

© 2004 Siebert et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction

Antiviral treatment (AVT) has been shown to be efficacious and cost-effective in clinical trial-based populations with chronic hepatitis C (CHC). However, comorbidity such as HIV/HCV coinfection, hemophilia, and history of i.v. drug use may impact long-term effectiveness and costs in the real world. The objective of this study was to assess the cost-effectiveness of different AVT strategies considering comorbidity associated with CHC.

Methods

The German Hepatitis C Model (GEHMO) [1], [2] was extended and linked to CHC prevalence and incidence data to predict the population-based clinical and economic burden of CHC in the actual population in Germany. We considered heterogeneity regarding HCV genotype and CHC associated diseases (e.g., HIV co-infection, hemophilia, extra-hepatic manifestations). We evaluated the following policies: (1) no AVT, (2) interferon monotherapy, (3) interferon plus ribavirin, and (4) pegylated interferon plus ribavirin. For each policy, we calculated total incident clinical events, CHC-related deaths, population life years (LY), quality-adjusted life years (QALY), costs, and incremental cost-effectiveness ratios (ICER). Pooled efficacy data from meta-analyses of randomised clinical trials [3], [4], [5], [6], literature-based epidemiologic data on comorbidities, quality of life data from the German Hepatitis C Quality of Life Study (n=428), and actual variable costs and reimbursement costs in the German health care system were used. Target population was all treatable treatment-naïve patients with known CHC and elevated transaminases in Germany. A lifelong time horizon and a societal perspective were adopted.

Results

Based on our analyses, without antiviral therapy, HCV would cause more than 29,000 cases of liver cirrhosis and 16,000 CHC-related deaths during the next 20 years resulting in a need of 1,200 liver transplantations. Peginterferon plus ribavirin is expected to prevent about half of these events. On average, pegylated interferon plus ribavirin increased life expectancy by more than 4 years and lifetime costs by 76,000 EUR when compared to no antiviral treatment. Discounted ICER of pegylated interferon plus ribavirin was 23,000 EUR/QALY.

Discussion

We conclude, that although CHC-related comorbidity decreases long-term effectiveness and increases lifetime cost of CHC treatment in the real world, peginterferon plus ribavirin is the most effective AVT and remains cost-effective when compared to other well-accepted medical therapies.

This study is limited by the fact that HCV-subpopulations such as children, acute HCV-infections, treatment relapsers or non-responders, and active i.v. drug-users were not considered. The results may vary substantially for those patient groups. The results may also differ from those of HCV-populations in other countries with different epidemiology. However, pegylated interferon plus ribavirin remained cost-effective in sensitivity analyses across a broad rage of parameters including mortality, quality of life and costs of comorbidities.

Acknowledgments

This work was commissioned and funded by the German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information (DAHTA@DIMDI), German Federal Ministry of Health and Social Security [Grant No. 05 / 01.2.] and the HepatitisCKoalition.


References

1.
Siebert U, Sroczynski G, Rossol S, Wasem J, Ravens-Sieberer U, Kurth BM, et al. Cost effectiveness of peginterferon alpha-2b plus ribavirin versus interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis C. Gut. 2003;52(3):425-32.
2.
Siebert U, Sroczynski G. Antivirale Therapie bei Patienten mit chronischer Hepatitis C in Deutschland. Medizinische und ökonomische Evaluation der initialen Kombinationstherapie mit Interferon / Peginterferon und Ribavirin. Köln: Deutsche Agentur für Health Technology Assessment des Deutschen Instituts für Medizinische Dokumentation und Information, 2003.
3.
Kjaergard L, Krogsgaard K, Gluud C. Interferon alfa with or without ribavirin for chronic hepatitis C: systematic review of randomised trials. BMJ 2001;323(7322):1151-1155.
4.
Kjaergard L, Krogsgaard K, Gluud C. Ribavirin with or without alpha interferon versus no intervention, placebo or alpha interferon for chronic hepatitis C (Cochrane Review). Cochrane Database of Systematic Reviews 2002(1).
5.
Manns M, McHutchison J, Gordon S, Rustgi V, Shiffman M, Reindollar R, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001;358(9286):958-965.
6.
Fried M, Shiffman M, Reddy R, Smith C, Marino G, Goncales F, et al. Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis C Virus Infection. N Engl J Med 2002;347:975-982