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- Title
Watchful waiting with periodic liver biopsy versus immediate empirical therapy for histologically mild chronic hepatitis C. A cost-effectiveness analysis.
- Authors
Wong, John B.; Koff, Raymond S.; Wong, J B; Koff, R S
- Abstract
<bold>Background: </bold>Not all patients with histologically mild chronic hepatitis C progress to cirrhosis.<bold>Objective: </bold>To compare no antiviral treatment, periodic liver biopsy with subsequent antiviral treatment for moderate hepatitis or cirrhosis, and immediate antiviral therapy.<bold>Design: </bold>Cost-effectiveness analysis.<bold>Data Sources: </bold>Clinical trial data and published studies.<bold>Target Population: </bold>Hepatitis C virus-infected patients with histologically mild hepatitis.<bold>Time Horizon: </bold>Lifetime.<bold>Perspective: </bold>Societal.<bold>Intervention: </bold>Immediate combination antiviral treatment or biopsy every 3 years plus combination antiviral therapy for moderate hepatitis or cirrhosis.<bold>Outcome Measures: </bold>Life expectancy, quality-adjusted life expectancy, and costs.<bold>Results Of Base-case Analysis: </bold>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.<bold>Results Of Sensitivity Analysis: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
HEPATITIS C treatment; TREATMENT of cirrhosis of the liver; LIVER biopsy; COST effectiveness
- Publication
Annals of Internal Medicine, 2000, Vol 133, Issue 9, p665
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-133-9-200011070-00008