 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
7 November 2000 | Volume 133 Issue 9 | Pages 665-675
Background: Not all patients with histologically mild chronic hepatitis C progress to cirrhosis.
Objective: To compare no antiviral treatment, periodic liver biopsy with subsequent antiviral treatment for moderate hepatitis or cirrhosis, and immediate antiviral therapy.
Design: Cost-effectiveness analysis.
Data Sources: Clinical trial data and published studies.
Target Population: Hepatitis C virus–infected patients with histologically mild hepatitis.
Time Horizon: Lifetime.
Perspective: Societal.
Intervention: Immediate combination antiviral treatment or biopsy every 3 years plus combination antiviral therapy for moderate hepatitis or cirrhosis.
Outcome Measures: Life expectancy, quality-adjusted life expectancy, and costs.
Results of Base-Case Analysis: Over 20 years, biopsy every 3 years with treatment of moderate hepatitis would avoid treatment in 50% of the cohort and would result in an 18% likelihood of cirrhosis compared with 16% for immediate treatment and 27% for no antiviral therapy. Immediate antiviral treatment should increase life expectancy by 1.0 quality-adjusted life-year compared with biopsy management. Over an average lifetime, biopsy management would lead to six liver biopsies costing $6200; immediate antiviral treatment would cost $5100 less than biopsy management because of savings related to biopsy and prevention of future hepatitis C–related morbidity. Immediate therapy was cost-effective compared with biopsy management and had a cost-effectiveness ratio of $7000 compared with no antiviral therapy.
Results of Sensitivity Analysis: When age, sex, genotype, and estimates of histologic progression or compliance with follow-up are varied, immediate therapy should result in an increase of at least 0.8 quality-adjusted life-year compared with biopsy management.
Conclusion: For histologically mild chronic hepatitis C, initial combination treatment compared with periodic liver biopsy should reduce the future risk for cirrhosis, prolong life, and be cost-effective.
Author and Article Information
for the International Hepatitis Interventional Therapy Group
Disclosure: Dr. Wong received research support from the Schering-Plough Research Institute for this study. Dr. Koff has research support from the Schering-Plough Research Institute for this and other clinical research studies, and he serves as a consultant to Schering-Plough Corp.
Grant Support: In part by Schering-Plough Corp., Kenilworth, New Jersey.
Requests for Single Reprints: John B. Wong, MD, New England Medical Center, 750 Washington Street, Box 302, Boston, MA 02111; e-mail, jwong{at}lifespan.org.
Current Author Addresses: Dr. Wong: New England Medical Center, 750 Washington Street, Box 302, Boston, MA 02111.
Dr. Koff: University of Massachusetts Memorial Health Care, Shaw Building, SH–143, 55 Lake Avenue North, Worcester, MA 01655.
Author Contributions: Conception and design: J.B. Wong, R.S. Koff.
Analysis and interpretation of the data: J.B. Wong.
Drafting of the article: J.B. Wong, R.S. Koff.
Critical revision of the article for important intellectual content: J.B. Wong, R.S. Koff.
Final approval of the article: J.B. Wong, R.S. Koff.
Statistical expertise: J.B. Wong.
Obtaining of funding: J.B. Wong.
Administrative, technical, or logistic support: J.B. Wong.
Collection and assembly of data: J.B. Wong. ARTICLE
Watchful Waiting with Periodic Liver Biopsy versus Immediate Empirical Therapy for Histologically Mild Chronic Hepatitis C: A Cost-Effectiveness Analysis
From Tupper Research Institute, New England Medical Center, Tufts University School of Medicine, Boston, and UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  J. Lambert, P. Halfon, G. Penaranda, P. Bedossa, P. Cacoub, and F. Carrat How to Measure the Diagnostic Accuracy of Noninvasive Liver Fibrosis Indices: The Area Under the ROC Curve Revisited Clin. Chem., August 1, 2008; 54(8): 1372 - 1378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Driffield and P. C. Smith A Real Options Approach to Watchful Waiting: Theory and an Illustration Med Decis Making, March 1, 2007; 27(2): 178 - 188. [Abstract] [PDF]
|
|
|
|
 |
|
 U Siebert, J Wasem, S Rossol, G Sroczynski, P Aidelsburger, U Ravens-Sieberer, B M Kurth, M P Manns, J G McHutchison, and J B Wong Antiviral treatment initiation costs in chronic hepatitis C Gut, January 1, 2005; 54(1): 172 - 173. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A Salomon, M. C Weinstein, and S. J Goldie Taking account of future technology in cost effectiveness analysis BMJ, September 25, 2004; 329(7468): 733 - 736. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Salomon, M. C. Weinstein, J. K. Hammitt, and S. J. Goldie Cost-effectiveness of Treatment for Chronic Hepatitis C Infection in an Evolving Patient Population JAMA, July 9, 2003; 290(2): 228 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Allen, A. C. Spaulding, A. M. Osei, L. E. Taylor, A. M. Cabral, and J. D. Rich Treatment of Chronic Hepatitis C in a State Correctional Facility Ann Intern Med, February 4, 2003; 138(3): 187 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. C. Kuehne, U. Bethe, K. Freedberg, and S. J. Goldie Treatment for Hepatitis C Virus in Human Immunodeficiency Virus-Infected Patients: Clinical Benefits and Cost-effectiveness Arch Intern Med, December 9, 2002; 162(22): 2545 - 2556. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Salomon, M. C. Weinstein, J. K. Hammitt, and S. J. Goldie Empirically Calibrated Model of Hepatitis C Virus Infection in the United States Am. J. Epidemiol., October 15, 2002; 156(8): 761 - 773. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 X.-M. Zhang, D. G. Mitchell, H. Shi, G. A. Holland, L. Parker, S. K. Herrine, D. Pasqualin, and R. Rubin Chronic Hepatitis C Activity: Correlation with Lymphadenopathy on MR Imaging Am. J. Roentgenol., August 1, 2002; 179(2): 417 - 422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Herrine Approach to the Patient with Chronic Hepatitis C Virus Infection Ann Intern Med, May 21, 2002; 136(10): 747 - 757. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Kisloff Periodic Liver Biopsy for Mild Hepatitis C Ann Intern Med, September 4, 2001; 135(5): 381 - 381. [Full Text] [PDF]
|
|
|
|
 |
|
 Periodic Liver Biopsies vs. Immediate Therapy for Mild Chronic HCV Infection Journal Watch Gastroenterology, January 16, 2001; 2001(116): 10 - 10. [Full Text]
|
|
|
|
 |
|
 Hepatitis C with Mild Inflammation: Consider Treatment Journal Watch (General), November 21, 2000; 2000(1121): 2 - 2. [Full Text]
|
|
Article
