Costo efficacia di peginterferone a-2a + ribavirina verso peginterferone a-2b + ribavirina nel trattamento dell’epatite cronica di tipo C in pazienti non pretrattati

The objective of this study was to evaluate the cost-effectiveness of peginterferon a-2a plus ribavirin versus peginterferon a-2b plus ribavirin as initial therapy for patients with Chronic Hepatitis C (CHC).We used a pre-existent Markov model of disease progression in which two cohorts of patients received peginterferon a-2a plus ribavirin or peginterferon a-2b plus ribavirin for 48 weeks and were followed for their expected lifetimes. The reference patient was a 45-year-old male with CHC without cirrhosis. The sustained virological responses (SVR) with peginterferon a-2a plus ribavirin and peginterferon a-2b plus ribavirin, were taken from two different publications. Utilities and costs for each health state were based on literature estimates and on Italian treatment patterns. Costs in 2005 euros and benefits were discounted at 3%. Sensitivity analyses on key clinical and economic parameters were performed. The analysis was conducted from the perspective of the Italian National Health Service.For the two cohorts expected life-years with peginterferon a-2a plus ribavirin versus peginterferon a-2a plus ribavirin were respectively 30.85 and 30.15 years. Quality-adjusted life years for peginterferon a-2a plus ribavirina were 17.69, and for peginterferon a-2b plus ribavirin were 17.08. The expected cost was €18,272 with peginterferon a-2a plus ribavirin and €18,549 with peginterferon a-2b plus ribavirin.This economic evaluation suggests that peginterferon a-2a plus ribavirin is a dominant strategy versus peginterferon a-2b plus ribavirin for treatment of adults with CHC, under some assumptions regarding treatment effectiveness and model structure.