International Journal of Technology Assessment in Health Care

ASSESSMENTS

SHORTENED PEGINTERFERON AND RIBAVIRIN TREATMENT FOR CHRONIC HEPATITIS C

Debbie Hartwella1, Jeremy Jonesa2, Louise Baxtera2 and Jonathan Shepherda2

a1 e-mail: d.hartwell@soton.ac.uk

a2 Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, First Floor Epsilon House, Enterprise Road, Southampton Science Park, Southampton SO16 7NS

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 C;
  • Cost-effectiveness;
  • Economic evaluation;
  • Peginterferon alfa;
  • Systematic review

Footnotes

  We thank members of our advisory group panel who provided expert clinical advice and comments on a draft of the full report, and Karen Welch (Information Scientist, SHTAC) for generating and running the literature searches for the full report. This work was completed as part of an update review funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number 08/98/01) and commissioned on behalf of the National Institute for Health and Clinical Excellence (NICE). It has been used in the NICE technology appraisal process (http://guidance.nice.org.uk/TA200/Guidance/pdf/English). The full report evaluating treatment in all the patient subgroups affected by the licence extensions has been published in Health Technology Assessment 2011;15(17) (see the HTA Programme Web site [www.hta.ac.uk] for further project information). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR HTA Programme. Ethics approval was not required.