Treating genotype 1 chronic hepatitis C with alpha pegylated interferons (2a and 2b) andribavirin : a cost-effectiveness analysis.

1. Universidade Federal Fluminense Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social Instituto de Medicina Social
Departamento de Saúde e Sociedade Programa de Estudos em Avaliação de
Tecnologias e Economia da Saúde
 
Gabriela Bittencourt Gonzalez Mosegui, Cid Manso de Mello Vianna,
Marcus Paulo da Silva Rodrigues, Renata de Mello Perez

2.  HEPATITIS C INFECTION IN BRAZIL
 PHARMACOLOGICAL TREATMENTS
 BRAZIL´S REALITY

3.  TO ANALYSIS THE COST-EFFECTIVENESS AND
BUDGET IMPACT OF RECOMMENDED
TREATMENTS FOR ADULTS INFECTED WITH
GENOTYPE 1 CRONIC HEPATITIS C, BASED ON A
COMPARISON OF ALPHA PEGUINTERFERON
COMBINED THERAPY-ASSOCIATED 2A AND 2B AND
RIBAVIRIN WITH NON-TREATMENT

4.  A MARKOV MODEL
 PUBLIC HEALTH SYSTEM (SUS) PERSPECTIVE
 DUAL THERAPY WITH 2A ALPHA PEGUINTERFERON
VS, 2B ALPHA PEGUINTERFERON (BOTH WITH
RIBAVIRIN)
 DATA
 MEASURES OF EFFECTIVENESS

5. Table 1 - Effectiveness of treatment for HCV with 2a alpha peguinterferon +
ribavirin and 2b alpha peguinterferon + ribavirin
2a Alpha 2b Alpha
peginterferon + peguinterferon +
ribavirin ribavirin
Sustained viral response 0,49 0,48
(SVR)
Early viral response 0,81 0,76
(EVR)
Probability of reaching 0,6049 0,6315
SVR
Source: Malone et al, 2005.
 ASSUMPTIONS
 UTILITY MEASURES

6.  Cost-effectiveness
Table 2 - Years of life gained according to the treatment strategies
2a Alpha 2b Alpha
Natural
Effectiveness peguinterferon peguinterferon +
History
+ ribavirin ribavirin
QUALY (5%
12,19 13,86 13,82
discount)
QUALY
(without 20,70 24,74 24,64
discount)
QUALY (10%
8,37 9,20 9,18
discount)
Costs in US dollars and effectiveness in QALYs

7. Table 3 - Cost-effectiveness of strategies for hepatitis C treatment for
a 1,000 patients for 30 year cohort
Incr
Strategy Costs Incr Costs Effectiv C/E (ICER)
Effectiv
Natural History 3,245.73 12.19 266.26
2a alpha PegInter
21,933.69 18,687.96 13.86 1.68 1,582.52 11,123.79
+ Ribavirin
2b alpha Peginter
26,752.20 4,818.51 13.82 0.04 1,935.76 (Dominated)
+ Ribavirin
All options related to the Natural History
Natural History 3,245.73 12.19 266.26
2a alpha PegInter
21,933.69 18,687.96 13.86 1.68 13,055.77 11,123.79
+ Ribavirin
2b alpha Peginter
26,752.20 23,506.47 13.82 1.63 1,935.76 14,421.15
+ Ribavirin
Costs in US dollars and effectiveness in QALYs
Quotation in 05/01/2012

8.  AS THERE WERE NO SIGNIFICANT DIFFERENCES
BETWEEN THE EFFECTIVENESS OF THE TWO
ALPHA PEGUINTERFERONS
 THE CHOICE BETWEEN ONE OR
ANOTHER MEDICINE DEPENDS ON THE PRICE
BEING CHARGED
 SENSITIVITY ANALYSIS HAS
SHOWN THAT USING THE PRICE OF A DRUG IN THE
OTHER, IT IMPLIES A CHANGE IN THE
CONCLUSIONS ALREADY REACHED BEFORE

9.  LIMITATIONS
 THE RECOMMENDATION OF THE STUDY IS THAT
THE CHOICE COST-EFFECTIVE USE OF ALPHA
PEGUINTERFERON 2A OR 2B DEPENDS ON THE
PRICE YOU CAN GET IN THE ACQUISITION OF EACH
OF THESE DRUGS.

10.  CONSELHO NACIONAL DE DESENVOLVIMENTO
CIENTÍFICO E TECNOLÓGICO – CNPq
 UNIVERSIDADE FEDERAL FLUMINENSE
 UNIVERSIDADE DO ESTADO DO RIO DE JANEIRO
 PROGRAMA DE ESTUDOS EM AVALIAÇÃO DE
TECNOLOGIAS E ECONOMIA DA SAÚDE