Nicole G. Campos, MSc, Harvard University, Cambridge, MA, Joshua A. Salomon, PhD, Harvard School of Public Health, Cambridge, MA, David P. Nunes, MD, Boston Medical Center, Boston University School of Medicine, Boston, MA, Jeffrey H. Samet, MD, MA, MPH, Boston Medical Center, Boston University School of Medicine, Boston, MA, Kenneth A. Freedberg, MD, MSc, Massachusetts General Hospital, Boston, MA, and Sue J. Goldie, MD, MPH, Harvard School of Public Health, Cambridge, MA.
Purpose: Approximately 30% of HIV-infected persons in the U.S. are co-infected with hepatitis C (HCV). With increasing survival secondary to effective antiretroviral therapy, co-infected patients are now vulnerable to HCV-related chronic liver disease. Our objective was to use recent data to examine the cost-effectiveness (CE) of treating HCV in an urban cohort of HIV-HCV patients. Methods: A state-transition model of HCV was used to estimate lifetime costs (2004 US$), life expectancy (LE), and incremental cost per year of life saved (YLS) for three treatment strategies: (1) interferon-alfa+ribavirin; (2) pegylated interferon-alfa; and (3) pegylated interferon-alfa+ribavirin. Population characteristics were derived from subgroups of the HIV-Longitudinal Interrelationships of Viruses and Ethanol (HIV-LIVE) and the Hepatitis and AIDS Liver Outcomes (HALO) study cohorts that were co-infected with HCV and eligible for treatment. The mean age of treatment-eligible patients was 44 years; 66% had genotype 1 HCV, 16% had cirrhosis, and 98% had CD4 counts >200 cells/mm3. Other data were from clinical trials, cost databases, and literature. We varied treatment efficacy from 10-70% and evaluated alternative assumptions about effects of HIV on fibrosis progression and cost. Results: The pegylated interferon-alfa+ribavirin treatment was consistently more effective and cost-effective than other treatment strategies, and was most cost-effective in patients with non-genotype 1 HCV and CD4 counts >500 cells/mm3. For patients with CD4 >500 cells/mm3, survival benefits ranged from 7-15 months, and incremental CE ratios were consistently less than $60,000/YLS for men and women of both genotypes. Due to better treatment efficacy in non-genotype 1 patients, this group experienced greater LE gains and lower CE ratios of $30,400/YLS in men and $29,500/YLS in women. CE ratios increased for patients with CD4 counts 200-500 cells/mm3, but remained under $75,000/YLS. Conclusions: Treatment for HCV in selected co-infected patients appears to be cost-effective, but highly sensitive to treatment efficacy. As eligible co-infected patients are not currently the norm, further studies are needed to establish the effectiveness of combination HCV therapy in populations with low eligibility for treatment.
See more of Oral Concurrent Session K - Clinical Strategies or Guidelines
See more of The 27th Annual Meeting of the Society for Medical Decision Making (October 21-24, 2005)
