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SHORTENED PEGINTERFERON AND RIBAVIRIN TREATMENT FOR CHRONIC HEPATITIS C

Published online by Cambridge University Press:  21 September 2012

Debbie Hartwell ,
Jeremy Jones ,
Louise Baxter  and
Jonathan Shepherd
Debbie Hartwell
Affiliation:
e-mail: d.hartwell@soton.ac.uk
Jeremy Jones
Affiliation:
Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, First Floor Epsilon House, Enterprise Road, Southampton Science Park, Southampton SO16 7NS
Louise Baxter
Affiliation:
Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, First Floor Epsilon House, Enterprise Road, Southampton Science Park, Southampton SO16 7NS
Jonathan Shepherd
Affiliation:
Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, First Floor Epsilon House, Enterprise Road, Southampton Science Park, Southampton SO16 7NS
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Abstract

Background: Peginterferon alfa and ribavirin combination therapy is an effective treatment for many patients with chronic hepatitis C virus (HCV). Reducing the length of treatment may be advantageous. We performed a systematic review and economic evaluation to assess shorter treatment duration of this regimen.

Methods: We searched fourteen bibliographic databases (including The Cochrane Library, Medline, and Embase) from 2000 to October 2009 and consulted experts and drug manufacturers. Eligible articles were randomized controlled trials (RCTs) selected according to predefined criteria. We undertook an economic evaluation to assess the cost-effectiveness of shortened treatment versus standard treatment in the UK.

Results: Six trials were included. In the sub-group of patients who had low viral load (LVL) and a rapid virological response (RVR), there were no statistically significant differences in sustained virological response (SVR) rates between patients who received standard treatment (range, 83 percent to 100 percent) and those who received shortened courses (range 84 percent to 96 percent) (24 weeks for genotype 1, 16 weeks for genotype 2/3). Shortened treatment resulted in cost savings, but in some scenarios also resulted in poorer outcome, compared with standard treatment. This requires a judgment to be made on the value of the quality-adjusted life-year loss resulting from adopting a shorter treatment regimen, if shorter treatment is associated with a lower SVR than standard treatment duration.

Conclusions: For chronic HCV patients who have LVL and achieve an RVR, shortened peginterferon and ribavirin combination therapy could be considered as a viable treatment option.

Keywords

Chronic hepatitis CCost-effectivenessEconomic evaluationPeginterferon alfaSystematic review
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 4 , October 2012 , pp. 398 - 406
Copyright
Copyright © Cambridge University Press 2012

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