Doctors at Harvard University conclude in a new study that the
treatments available for hepatitis C are reasonably cost effective,
and their benefits depend on each individual's perception of how HCV
therapy increases their quality of life.(1)

Joshua Salmon, Ph.D., of the Harvard School of Public Health, and
his colleagues examined the clinical benefits and cost-effectiveness
of newer treatments for chronic hepatitis C in a group of HCV
positive patients based on an epidemiologic model they designed that
simulates real-life applications.

Treatment Impact
To make those assessments, the researchers measured the natural
history of HCV infection, and the impact of treatment. They reported
that the model was designed so that it mimicked actual data on both
the prevalence of hepatitis C infection, and outcomes related to HCV
infection based on a set of predefined parameters.

They then based the data collected in their model on a group of
patients with elevated levels of alanine aminotransferase (ALT), who
tested positive for antibodies to HCV, and had no evidence of
fibrosis. Elevated ALT is an indicator of a sick liver.

Each patient was either using standard or pegylated interferon alfa-
2b (Intron-A or Peg-Intron) either in combination with the antiviral
medication ribavirin or as monotherapy, Salomon and his colleagues
reported.

The study's objectives included assessment of lifetime costs, life
expectancy, and quality-of-life measurements.

Hepatitis Predictions
They found that the likelihood of patients with chronic HCV
developing cirrhosis over a 30-year period ranged from 13 to 46
percent for men and 1 to 29 percent for women. The incremental cost-
effectiveness of combination therapy with pegylated interferon for
men ranged from $26,000 to $64,000 per year for patients with the
strain of hepatitis C known as "genotype 1", and about $32,000 to
approximately $90,000 per year for all other genotypes.

For women, costs ranged from $32,000 to $90,000 per year for those
with genotype 1, and $12,000 to $42,000 for other genotypes.

The investigators concluded that treatments appear to be cost-
effective, but outcomes obviously vary from individual to individual.

"While newer treatment options for hepatitis C appear to be
reasonably cost-effective on average, these results vary widely
across different patient subgroups and depend critically on quality-
of-life assumptions," wrote the doctors. "As the pool of persons
eligible for treatment for HCV infection expands to the more general
population, it will be imperative for patients and their physicians
to consider these assumptions in making individual-level treatment
decisions."

The Role of Patient Age and Sex
More specifically, factors like age and sex appear to play a major
role in the rate disease progression.

"Based on our analyses, treatment for women may offer substantially
lower benefits than treatment for men because women have a much
lower probability of progressing to cirrhosis and liver failure,"
they wrote. That information may also be helpful to women and their
doctors as they weigh the risks and benefits of treatment, Salomon
and his colleagues stressed.

Hepatitis Incidence
It is estimated that approximately 3.9 million people in the United
States are infected with hepatitis C. Most infections are due to
illegal drug use, and the number of new infections increases by
about 25,000 per year. HCV is the most common form of hepatitis.

Transmission occurs when blood, and rarely bodily fluids, from an
infected person come into contact with blood from a non-infected
person.(2)

1. Salomon J et al. Cost-effectiveness of treatment for chronic
hepatitis C infection in an evolving patient population. JAMA 2003
Jul 9;290:228-37.

2. Centers for Disease Control and Prevention. Viral Hepatitis C.