Long-term effectiveness and cost-effectiveness of antiviral treatment in hepatitis C

We systematically reviewed the evidence for long‐term effectiveness and cost‐effectiveness of antiviral treatment in patients with chronic hepatitis C. We performed a systematic literature search on the long‐term effectiveness and cost‐effectiveness of AVT in hepatitis C (1990–March 2007), and included health technology assessment (HTA) reports, systematic reviews, long‐term clinical trials, economic studies conducted alongside clinical trials and decision‐analytic modelling studies. All costs were converted to 2005€. Antiviral therapy with peginterferon plus ribavirin in treatment‐naïve patients with chronic hepatitis C was the most effective (3.6–4.7 life years gained [LYG]) treatment and was reasonably cost‐effective (cost‐saving to 84 700€/quality adjusted life years [QALY]) when compared to interferon plus ribavirin. Some results also suggest cost‐effectiveness (below 8400€/(QALY) of re‐treatment in nonresponders/relapsers. Results for patients with persistently normal alanine aminotransferase (ALT) levels or with special co‐morbidities (e.g. HIV) or risk profiles were rare. We conclude that antiviral therapy may prolong life, improve long‐term health‐related quality‐of‐life and be reasonably cost‐effective in treatment‐naïve patients with chronic hepatitis C as well as in former relapsers/nonresponders. Further research is needed in patients with specific co‐morbidities or risk profiles.