To Register      SMDM Homepage

Monday, 18 October 2004 - 11:15 AM

This presentation is part of: Oral Concurrrent Session A - Public Health 1

POPULATION-BASED ASSESSMENT OF FUTURE BURDEN OF DISEASE AND COSTS RELATED TO CHRONIC HEPATITIS C AND ASSOCIATED DISEASES IN GERMANY

Uwe Siebert, MD, MPH, MSc1, Gaby Sroczynski, MPH1, Pamela Aidelsburger, MD, MPH2, Eva Esteban, BS3, Jürgen Wasem, PhD2, Siegbert Rossol, MD4, and John B. Wong, MD, FACP5. (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 Munich, Program on HTA and Decision Sciences, Munich, Germany, (4) University of Heidelberg, Department of Internal Medicine, Rüsselsheim, Germany, (5) Tufts-New England Medical Center, Clinical Decision Making, Informatics and Telemedicine, BOSTON, MA

Purpose: Antiviral treatment (AVT) has been shown to be efficacious and cost-effective in clinical trial-based populations with chronic hepatitis C (CHC). However, most of these decision-analyses ignore co-morbid illness associated with CHC, leading to overly optimistic results. The objectives of this study were (1) to predict population-based clinical and economic burden of CHC and associated diseases for the next 20 years in Germany and (2) to examine the potential impact of antiviral treatments (AVT).

Methods: We linked the German Hepatitis C Model, a validated and published Markov model of CHC, to German CHC prevalence and incidence data to project the 20-year and lifetime morbidity, mortality and costs for all treatable patients with known CHC and elevated transaminases in Germany. The model considered HCV genotype and CHC-related diseases (e.g., HIV co-infection, hemophilia, extra-hepatic manifestations) and evaluated the following policies: (1) no AVT, (2) interferon monotherapy, (3) interferon plus ribavirin, and (4) pegylated interferon plus ribavirin. We used pooled treatment efficacy data from meta-analyses of randomized clinical trials, results from the German Hepatitis C Quality of Life Study (n=428), actual variable costs and reimbursement costs in the German health care system, and literature-based epidemiologic data on co-morbidities. For each policy, we calculated the incidence of clinical complications, CHC-related deaths, population life years (LY), quality-adjusted life years (QALY), costs, and incremental cost-effectiveness ratios (ICER). We adopted the societal perspective and used a 3% annual discount rate.

Results: In the absence of AVT during the next 20 years, HCV would cause more than 16,000 CHC-related deaths and 29,000 cases of liver cirrhosis leading to 1,200 liver transplantations. Peginterferon plus ribavirin would prevent about half of these complications and would add about 53,000 LY (or 49,000 QALYs) at a total cost of 1.3 billion EUR (undiscounted values). In the discounted lifetime analysis, peginterferon plus ribavirin was the most effective strategy with an ICER of 23,000 EUR/QALY compared with interferon mono-therapy (next non-dominated strategy). Peginterferon plus ribavirin remained cost-effective in sensitivity analyses across a broad rage of parameters including mortality, quality of life and costs of co-morbidities.

Conclusion: Incorporating co-morbid illnesses associated with CHC increased the ICER of peginterferon plus ribavirin, but treatment remained cost-effective when compared to other well-accepted medical technologies and would halve the burden of disease.


See more of Oral Concurrrent Session A - Public Health 1
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)