Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: A systematic review and economic evaluation

Abstract

Objectives: To assess the clinical effectiveness and cost-effectiveness of pegylated interferon alfa (PEG) and non-pegylated interferon alfa (IFN) and ribavirin (RBV) for the treatment of adults with histologically mild chronic hepatitis C (HCV) infection. Data sources: Electronic bibliographic databases were searched up to July 2005. Review methods: A systematic review and an economic evaluation were carried out. A Markov state transition model was developed to estimate the cost-effectiveness of treatment strategies for adults with mild chronic HCV. Results: Among the included studies, eight randomised controlled trials (RCTs) of antiviral treatment in mild HCV were identified and included. In general these RCTs were of good quality. The results suggested that effectiveness, particularly with respect to sustained virological response was similar in patients with mild disease to the results obtained in patients with moderate/severe disease. This finding was supported by RCTs reporting the results for mild HCV subgroups. The authors' cost-effectiveness analysis showed that early treatment compared with watchful waiting is associated with quality-adjusted life-year (QALY) gains but with increased treatment costs. The base-case incremental costs per QALY for 48 weeks of treatment are: watchful waiting with IFN + RBV versus best supportive care = £3097-6585; early treatment with IFN + RBV versus watchful waiting with IFN + RBV = £5043-8092; watchful waiting with PEG 2a + RBV versus best supportive care = £3052; early treatment with PEG 2a + RBV versus watchful waiting with PEG 2a + RBV = £5900; watchful waiting with PEG 2b + RBV versus best supportive care = £2534; and early treatment with PEG 2b + RBV versus watchful waiting with PEG 2b + RBV = £5774. These results were consistent with previous assessments of cost-effectiveness. Conclusion: This systematic review and economic evaluation show that patients with histologically mild HCV can be successfully treated with both pegylated and non-pegylated interferon alfa. Early treatment and watchful waiting strategies are associated with acceptable cost-per-QALY estimates. Research needs to be directed towards newer, potentially more effective interventions, particularly those that improve treatment response in patients with genotype I, with minimal adverse effects. Further research is required into the natural history of HCV to estimate better the rate of liver disease progression, and also into the effectiveness of non-invasive biochemical markers of liver disease, as an alternative to liver biopsy. © Queen's Printer and Controller of HMSO 2007. All rights reserved.