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How long to use combo treatment

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    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.
    Message 1 of 1 , Mar 7, 2002
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      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.

      http://www.medscape.com/viewarticle/422894?srcmp=ms-030102

      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,
      Barcelona, Spain

      Clin Drug Invest 21(1):31-39, 2002. � 2002 Adis
      International Limited

      Abstract

      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
      healthcare system.

      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
      system.

      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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