How long to use combo treatment
- Here is a link to an article about how to effectively
using combo treatment. I included the abstract, use
the link to see the rest the whole article.
Which is the Most Cost-Effective Combination Therapy
Strategy Using Interferon Alpha-2b Plus Ribavirin for
Naive Patients With Chronic Hepatitis C?
Maria Buti, Servicio de Hepatolog�a, Hospital Vall
d'Hebr�n, Paseo Vall d'Hebr�n, Barcelona, Spain;
Miguel A. Casado, Leslie Fosbrook, Schering-Plough,
Madrid, Spain Rafael Esteban, Servicio de Hepatolog�a,
Hospital Vall d'Hebr�n, Paseo Vall d'Hebr�n,
Clin Drug Invest 21(1):31-39, 2002. � 2002 Adis
Objective: To compare the cost effectiveness of
different therapeutic strategies using the combination
of interferon and ribavirin in the treatment of
patients with chronic hepatitis C.
Design and setting: This was a cost-effectiveness
analysis from the perspective of the Spanish
Methods: Six different therapeutic strategies were
compared using a decision-tree analysis and a Markov
model. These strategies, using combination therapy for
24 or 48 weeks depending on viral genotype and
hepatitis C virus (HCV) RNA, were compared on the
basis of incremental cost per additional life year
saved (LYS) and additional quality-adjusted life year
(QALY) saved. Clinical data were derived from major
clinical trials and costs from the Spanish healthcare
Results: For a base-case patient with chronic
hepatitis C, the most effective strategy was
combination therapy for 24 weeks for genotype non-1
and for 48 weeks for genotype 1 patients who cleared
HCVRNA before week 24. Using this strategy, life
expectancy increased by 0.07 to 0.38 years vs other
strategies and QALY increased 0.15 to 0.84 vs other
strategies. The incremental cost per LYS ranged from
cost saving to euros (EUR)1363, and per QALY from cost
saving to EUR 610 vs other strategies (2000 values,
converted to EUR at the official rate of 1EUR =
166.386 pesetas). The cost per LYS and QALY compared
with no therapy was EUR2368 and EUR1060, respectively.
This strategy permits the treatment of more patients
with the same budget than those strategies based only
on HCV genotyping or HCV RNA testing.
Conclusion: Defining the duration of combination
therapy for patients with chronic hepatitis C by
baseline genotyping and HCV RNA testing at week 24 is
the best strategy for standard clinical practice.
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