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Clinical Decisionmaking

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Newer treatments for hepatitis C infection appear to be cost effective, but results vary widely across different groups

Nearly 3 million people in the United States are chronically infected with the hepatitis C virus (HCV), which can lead to cirrhosis of the liver and liver cancer. However, aggressive screening is identifying more HCV-infected patients who are asymptomatic and otherwise healthy (no evidence of liver fibrosis). Since few of these individuals would progress to severe liver disease even in the absence of therapy, treatment benefits are largely for improved quality of life rather than survival gains. Treatment with newer pegylated interferon and ribavirin is more cost effective than standard interferon and ribavirin for these asymptomatic, healthy patients, according to a recent study. The researchers also found that this newer combination therapy offers substantially lower benefits for women than men, since women are much less likely to progress to cirrhosis and liver failure, even in the absence of treatment.

The study was conducted by researchers at Harvard University and the World Health Organization and supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00055). The researchers developed a model that simulated HCV disease progression under a variety of different treatment scenarios in an asymptomatic group of 40-year-old HCV-infected individuals who had no evidence of liver fibrosis.

See "Cost-effectiveness of treatment for chronic hepatitis C infection in an evolving patient population," by Joshua A. Salomon, Ph.D., Milton C. Weinstein, Ph.D., James K. Hammitt, Ph.D., and Sue J. Goldie, M.D., M.P.H., in the July 9, 2003, Journal of the American Medical Association 290(2), pp. 228-237.

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