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Based on the German Hepatitis C Model (GEHMO) we developed a Hepatitis C Policy Model and applied it to the heterogeneous German hepatitis C population within the German health care context. We used Markov cohort simulation to predict absolute clinical and economic outcomes for a 20-year time horizon. For the cost-effectiveness analysis, a lifelong time horizon was used. Four different strategies were compared: (1) no antiviral treatment, (2) interferon monotherapy, (3) combination therapy with interferon plus ribavirin, and (4) combination therapy with pegylated interferon plus ribavirin. Based on our model, antiviral therapy with pegylated interferon and ribavirin could prevent about 17,000 cases of cirrhosis, 580 liver transplants, and 7,600 HCV-related deaths and is expected to save about 53,000 life years at total costs of 1.3 billion Euros within the next 20 years. Pegylated interferon plus ribavirin was the most effective treatment with an incremental cost-utility ratio of 23,000 Euros per quality-adjusted life year saved.

Objective: The decision tree analysis is based on a study of v. Doern comparing the medical costs of a diagnosis by means of a traditional method (ONAST) to a new and quicker method (RAST). The conclusion is that, the traditional method proofs to be more expensive regarding different types of costs. A goal of this analysis was to prove the results of this US study for an application in the German health care system., Methods: A cost efficacy analysis by means of a decision tree was carried out measuring the costs using the surviving of patients as a parameter. As in the RAST group 24 out of 273 and in the ONAST group 46 in 300 persons died, the efficacy rates amount to 0.912 and 0.847, respectively. Finally, sensitivity analyses were performed., Results: Results of total (direct and indirect) costs per surviving patient showed an advantage of the RAST procedure amounting to DM 3,653 (28.3%) compared to the ONAST procedure. From the perspective of a German sickness fund, the RAST procedure leads to a saving potential of about DM 2,671 (13.0%) in comparison to the ONAST procedure. As a result, a minimum of 10 patients a year are required to save costs from the perspective of the hospital. If costs for drugs in the RAST procedure amount to DM 8,764.93, equality of total costs is obtained. This case is rather unlikely., Conclusion: From both perspectives of the payer as well as that of the hospital it can be concluded that the rapid method is more cost-effective than the overnight method.