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Treatment of chronic hepatitis C with Interferon (IFN) alpha2b monotherapy results in 10% to 15% sustained virological response (SVR). Combining IFN with ribavirin increases this response. In this analysis, using the Markov model, 6 treatment strategies for chronic hepatitis C (previously untreated) were compared on the basis of incremental cost per additional quality-adjusted life years (/QALY). Our results showed that the no treatment strategy was associated with a cost of 38, 747 and 13. 10 QALYs. The strategy using IFN alone for 48 weeks was associated with a cost of 35, 642 and 14. 05 QALYs. The strategy using IFN monotherapy followed by combination therapy for nonresponders and relapsers was associated with a cost of 34, 561 and 15. 53 QALYs. A similar strategy, but limiting combination to relapsers only, was associated with a cost of 34, 758 and 14. 40 QALYs. The strategy using IFN with ribavirin as the initial therapy for all patients was associated with a cost of 34, 792 and 15. 31 QALYs. Finally, the strategy using viral genotyping first and then adjusting the duration of combination therapy based on genotype was associated with a cost of 37, 263 and 15. 89 QALYs. The strategy using genotyping to guide duration of combination therapy was the most cost-effective approach with an incremental cost-effectiveness ratio of 7, 500 per QALY. Sensitivity analyses confirmed the robustness of these results. We conclude that combination of IFN and ribavirin with duration of therapy based on the viral genotype, is a cost-effective approach in treating patients with chronic hepatitis C.
Younossi et al. (Mon,) studied this question.