Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2006, vol. 15, nr 3, May-June, p. 453–462

Publication type: original article

Language: English

Cost Effectiveness of Replacing Recombinated Interferon α−2b with its Pegylated Form in Combination with Ribavirin for the Therapy of Chronic HCV Infection in Poland

Korzyści ekonomiczne zamiany rekombinowanego interferonu α−2b na jego postać pegylowaną w skojarzeniu z rybawiryną w terapii przewlekłego wirusowego zapalenia wątroby związanego z zakażeniem HCV w Polsce

Krzysztof Simon1,, Andrzej Gładysz1,, Katarzyna Rotter1,, Weronika Rymer1,, Patryk Smoliński1,, Małgorzata Inglot1,, Magdalena Władysiuk−Blicharz2,

1 Department of Infectious Diseases, Hepatology, and Acquired Immune Deficiencies, Silesian Piasts University of Medicine in Wrocław, Poland

2 HTA−consulting

Abstract

Objectives. This analysis was carried out in order to define the therapeutic effectiveness, costs, and profitability of treatment with peginterferon alpha−2b plus ribavirin in patients with chronic hepatitis C infection compared with treatment with interferon alpha−2b plus ribavirin or lack of treatment.
Material and Methods. Acohort of 743 HCV−infected patients treated in authors’ Department were analyzed. Calculations of the effects and costs of applying a combined treatment with IFN−alpha−2b plus ribavirin in patients with chronic hepatitis C were based on the assumptions of an economic analysis presented in the computer program “Spears Hepatitis C” using a Markov decision model. The cost analysis was carried out from the extended point of view of the payer (National Health Service, National Health Fund, and the patient) for a time−span equal to the average period of the clinical trials included in this analysis (48 weeks) and based on data concerning the effectiveness of the frequency of salubrious events obtained from clinical trials.
Results. It was demonstrated that treating patients with chronic hepatitis C with peginterferon + ribavirin in a weight−based dose is more efficient and cost effective than interferon + ribavirin therapy. The cost of PEG + RBV treatment (regardless of the ribavirin dose) for a 70−kg patient amounts to 40,534.27 PLN in the category of FULL costs, 32,236.71 PLN ACTUAL costs, 28,094.76 PLN STOP costs, and 23,700.12 PLN STOP 2/3 costs. The effectiveness analysis on the basis of a single clinical trial showed that undergoing therapy with peginterferon alpha2b plus ribavirin causes a prolongation of the patient’s life by at least 0.12 years (maximum: 0.70 years) compared with treatment with interferon alpha−2b plus ribavirin. Compared with lack of treatment, PEG + RBV therapy resulted in a prolongation of life from 1.84 to 4.03 years.
Conclusion. Treatment with pegylated interferon alpha−2b plus ribavirin is more effective and profitable than treatment with interferon alpha−2b plus ribavirin, regardless of the ribavirin dose, irrespective of the HCV genotype with which the patient is infected.

Streszczenie

Cel pracy. Określenie skuteczności terapeutycznej, kosztów i opłacalności leczenia peginterferonem α−2b z rybawiryną u pacjentów chorych na przewlekłe wirusowe zapalenie wątroby typu C w porównaniu z leczeniem interferonem α−2b z rybawiryną lub brakiem leczenia.
Materiał i metody. Ocenie poddano 743 pacjentów zakażonych HCV i leczonych w Katedrze i Klinice Chorób Zakaźnych, Chorób Wątroby i Nabytych Niedoborów Odporności. Obliczenia rezultatów i kosztów leczenia kombinowanego IFN−α−2b z ribawiryną u pacjentów z p.w.z.w. t.C oparto na założeniach analizy ekonomicznej przedstawionej w programie komputerowym Spears Hepatitis C wykorzystującym model decyzyjny Markowa. Analizę kosztów przeprowadzono z poszerzonej perspektywy płatnika (Kasa Chorych, NFZ + pacjent) dla horyzontu czasowego równego średniemu okresowi badań klinicznych włączonych do tej analizy (48 tyg.) oraz opierając się na danych dotyczących efektywności zdrowotnych częstości zdarzeń zdrowotnych, które uzyskano z badań klinicznych.
Wyniki. Wykazano, że leczenie pacjentów chorych na przewlekłe wirusowe zapalenie wątroby typu C za pomocą peginterferonu z rybawiryną w dawce zależnej od masy ciała jest leczeniem skuteczniejszym, także ze względów ekonomicznych, w porównaniu z terapią interferonem i rybawiryną. Koszt takiego leczenia (bez względu na dawkę rybawiryny) dla pacjenta, którego masa ciała wynosi 70 kg to: w kategorii kosztowej FULL 40 534,27 PLN, ACTUAL 32 236,71 PLN, STOP 28 094,76 PLN, STOP 2/3 23 700,12 PLN. Analiza skuteczności na podstawie pojedynczego badania klinicznego wykazała, że poddanie się terapii peginterferonem α−2b z rybawiryną powoduje u jednego pacjenta wydłużenie życia co najmniej o 0,12 roku, maksymalnie o 0,70 lat w porównaniu z leczeniem interferonem α−2b z rybawiryną. W porównaniu z brakiem leczenia terapia PEG + RYB powoduje wydłużenie życia od 1,84 do 4,03 roku.
Wnioski. Leczenie pegylowanym interferonem α−2b z rybawiryną jest leczeniem bardziej skutecznym i opłacalnym w porównaniu z leczeniem interferonem α−2b z rybawiryną (bez względu na dawkę rybawiryny), niezależnie od rodzaju genotypu HCV, jakim zakażeni są pacjenci.

Key words

HCV infection, pegylated interferon alpha−2b, ribavirin, economic analysis

Słowa kluczowe

zakażenie HCV, pegylowany interferon α−2b, ribawiryna, analiza ekonomiczna

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