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Outcomes research in chronic viral hepatitis C: effects of interferon therapy
1Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
Insights
Chronic hepatitis C (CHC) significantly reduces health-related quality of life (HRQOL). Interferon-based therapies improve HRQOL and are cost-effective, justifying their use despite limited long-term efficacy.
Area of Science:
- Hepatology
- Gastroenterology
- Public Health
Background:
- Chronic hepatitis C (CHC) is a significant cause of morbidity and the leading indication for liver transplantation in North America.
- CHC patients experience a marked reduction in health-related quality of life (HRQOL) compared to controls.
- This HRQOL reduction is more pronounced in CHC than in chronic hepatitis B.
Purpose of the Study:
- To review recent work on the impact of CHC on HRQOL.
- To assess the effectiveness and cost-effectiveness of CHC therapies on HRQOL.
Main Methods:
- Review of existing literature on CHC, HRQOL, and treatment outcomes.
- Analysis of cost-effectiveness data for interferon (IFN) and IFN plus ribavirin therapy.
Main Results:
- CHC significantly impairs patients' HRQOL.
- Successful therapy with type 1 interferons (IFNs) substantially improves HRQOL in CHC patients.
- IFN-based therapies for CHC are highly cost-effective, with quality-adjusted life year gains ranging from cost-saving to $11,400.
Conclusions:
- Current CHC therapies are justified by their significant positive impact on patient HRQOL.
- The cost-effectiveness of CHC treatment further supports its clinical utility.
- Despite limitations in long-term efficacy, improving HRQOL and cost-effectiveness are key benefits of CHC treatment.
Abstract:
Although chronic hepatitis C (CHC) is often mild and asymptomatic, it may lead to decompensated hepatic cirrhosis and death. CHC is now the single most important indication for liver transplantation in North America. CHC is also an important cause of morbidity. Recent work is reviewed and shows that the health-related quality of life (HRQOL) of patients with CHC is markedly reduced compared with that of age- and sex-matched controls. For as yet unknown reasons, this reduction is more severe in CHC patients than in those with chronic hepatitis B. Successful therapy of CHC with type 1 interferons (IFNs) leads to substantial improvement - to nearly normal levels - in patients' HRQOL. In addition, IFN or IFN plus ribavirin therapy for CHC is highly cost effective, despite its limited long term efficacy; estimates of the costs to gain one year of quality-adjusted life range from no cost (that is, therapy is cost saving) to US$11,400 (for those most difficult to cure). Thus, despite the limited effectiveness of current therapies for CHC, they are fully justified based on their beneficial effects on patients' HRQOL and their cost effectiveness.