To Register      SMDM Homepage

Monday, 18 October 2004

This presentation is part of: Poster Session - CEA: Methods and Applications; Health Services Research

EVALUATION OF LONG-TERM CLINICAL EFFECTIVENESS AND COST-EFFECTIVENESS OF THE NEW GENOTYPE-SPECIFIC GUIDELINES FOR CHRONIC HEPATITIS C TREATMENT IN GERMANY

Uwe Siebert, MD, MPH, MSc1, Gaby Sroczynski, MPH1, Pamela Aidelsburger, MD, MPH2, Siegbert Rossol, MD3, Jürgen Wasem, PhD2, Michael P. Manns, PhD, MD4, John G. McHutchison, MD5, and John B. Wong, MD, FACP6. (1) Massachusetts General Hospital, Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Boston, MA, (2) University of Duisburg-Essen, Alfried Krupp von Bohlen und Halbach-Chair for Medical Management, Essen, Germany, (3) University of Heidelberg, Department of Internal Medicine, Rüsselsheim, Germany, (4) Medical School of Hanover, Department of Gastroenterology and Hepatology, Hannover, Germany, (5) Duke University Medical Center, Hepatology Research, Durham, NC, (6) Tufts-New England Medical Center, Clinical Decision Making, Informatics and Telemedicine, BOSTON, MA

Purpose: The recently developed German guidelines for antiviral treatment (AVT) in patients with chronic hepatitis C (CHC) recommend basing drug dosage, intended treatment duration, and early stopping rules on the genotype of the hepatitis C virus (HCV). Therefore, we sought to evaluate the lifetime clinical effectiveness and cost-effectiveness of different AVT strategies including the new German guidelines on genotype-specific treatment.

Methods: The German Hepatitis C Model (GEHMO), a validated and published Markov model reflecting the German health care system and the practice patterns of German physicians, was used to project clinical events, life expectancy, quality-adjusted life years (QALY), and lifetime costs for the following AVT strategies: (1) no AVT (NoAVT), (2) Interferon alfa-2b plus ribavirin for 48 weeks (IFN), (3) Peginterferon alfa-2b plus ribavirin for 48 weeks (PEG), (4) Peginterferon alfa-2b plus ribavirin according to the German guidelines with genotype-dependent AVT duration, dosing and early stoppage in HCV-positive patients after 12 weeks (GUIDE). Incremental discounted cost-effectiveness ratios (ICER) were calculated from a societal perspective. Clinical data and actual drug utilization data were derived from a large multi-centre randomized clinical trial. Detailed data on long-term costs were based on German actual variable costs, reimbursement data, and health resource utilization data from the German Hepatitis C Patient Survey (n=196).

Results: Compared to NoAVT, combination therapy with peginterferon alfa-2b and ribavirin (PEG or GUIDE) reduced the 20-year risk for decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, and liver-related death by more than 50%. Compared to NoAVT, PEG increased life expectancy by 5.0 life years and GUIDE increased life expectancy by 4.9 years. GUIDE dominated IFN by strong dominance. Compared to NoAVT, discounted ICERs were 1500 EUR/QALY for GUIDE and 3300 EUR/QALY for PEG. GUIDE saved 3950 EUR per patient. Moving from GUIDE to PEG was associated with an ICER >100,000 EUR/QALY.

Conclusion: Administering combination therapy with peginterferon and ribavirin in accordance with the new German guidelines allows tailoring treatment efficiently to HCV genotype, body weight, and early viral response in patients with minimal loss of effectiveness. Antiviral treatment according to the new German guidelines should be cost-effective compared to other well-accepted medical interventions.


See more of Poster Session - CEA: Methods and Applications; Health Services Research
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)