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"A La Carte" Therapy More Cost-Effective Than Standard Combination for Treatment-Naive Patients With Chronic Hepatitis C: Presented at AASLD

By Maria Bishop

BOSTON, MA -- October 30, 2006 -- The direct health-care costs associated with treatment of chronic hepatitis C can be minimised by offering "a la carte" therapy instead of standard combination therapy with pegylated interferon alpha 2b and ribavirin, researchers reported here at the 57^th Annual Meeting of the American Society for Liver Diseases (AASLD).

In addition, cost reduction is achieved without compromising the rates of sustained virological response (SVR).

Monitoring rapid virological response (RVR) and early virological response (EVR) is crucial to achieving this goal, noted lead investigator Maria Buti, MD, professor of medicine, department of hepatology, Hospital Vall d'Hebron, Barcelona, Spain. This is because both EVR and RVR are important predictors of treatment outcome in patients receiving a standard combination therapy of pegylated interferon alpha 2b and ribavirin.

Dr. Buti and colleagues previously reported that patients in this population who do not achieve EVR are not likely to ever achieve SVR and, therefore, can be discontinued from standard therapy. From the perspective of the Spanish health-care system, early therapy discontinuation lowers costs as well as preventing adverse events and unnecessary treatment exposure.

For the purposes of this study, presented on October 28^th, RVR was defined as undetectable hepatitis C virus (HCV) ribonucleic acid (RNA) after 4 weeks of treatment, and EVR was defined as undetectable HCV RNA at week 12.

Two treatment strategies were applied to a cohort of 26,434 patients being treated in Spain. Baseline characteristics were calculated according to the results in the literature. Published EVR and RVR rates were used to predict SVR rates among both treatment groups, which were further broken into genotype (G1, 74%; G2/3, 26%).

The researchers constructed a budgetary impact model using a decision-tree analysis to compare (a) peginterferon alfa-2b and weight-based ribavirin for 24 weeks (G2/3) or 48 weeks (G1) with a 12-week stopping rule for non-EVR and (b) a la carte therapy: the same therapy dosage but different duration depending on RVR and HCV genotype. In this second group, patients in G1 and RVR, 24 weeks of therapy; G1 and no RVR, 48 weeks; G2/3 and RVR, 12 weeks; G2/3 and no RVR, 24 weeks.

Both standard combination therapy and therapy a la carte strategies resulted in similar rates of SVR (50% and 55%, respectively), but total costs were higher with combination therapy than with therapy a la carte (overall savings of 25% -- over $75,000 US -- or $7,000 per patient who achieved an SVR). The savings are even greater among G1 patients.

Dr. Buti and her colleagues all serve as consultants for Schering Plough.


[Presentation title: Therapy a la Carte Is More Cost-Effective Than Standard Combination Therapy for Naive Patients With Chronic Hepatitis C. Abstract 359]

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