Standard interferon-alpha in genotype 1 hepatitis С virus: a clinical and economic analysis of its effectiveness
The objective.To study a comparative clinical and economic effectiveness of two therapeutic regimens with the use of standard and pegylated interferon-? (PegIFN-?) for chronic hepatitis С (CHC) caused by genotype 1 virus. Patients and methods. The study included 120 patients with CHC confirmed by virological, biochemical and histological methods. The basic group that included 80 patients received IFN-?2b 3 mln IU ? 3 times/wk subcutaneously and ribavirin 15 mg/kg daily per os for 48 wks. The reference group of 40 received PegIFN-?2а 180 mkg a week subcutaneously in combination with ribavirin in a similar dose also for 48 wks. The observation period aimed at assessment of sustained virological response (SVR) was 24 wks. Results. The frequency of obtaining rapid virological response (RVR) was 63.8 and 75.0%, complete early virological response (EVR) – 77.5 and 85.0%, partial EVR – 3.8 and 3.2%, response by the moment of termination of the course – 7.5 and 80.0%, SVR – 57.5 and 70.0%, respectively (p >- 0.05 for al values). In the group of standard IFN-? SVR was stated in 78.4% of patients in case of RVR and 20.1% in its absence. The both therapeutic schemes were comparable by the frequency of side effects, but in the group receiving standard IFN-? a lesser incidence of depression, neutropenia and thrombocytopenia was noted. The «cost– effectiveness» coefficient in using standard IFN-? was by 3.2 times less than such in using PegIFN-?. Analysis of sensitivity of the obtained results to the change of drug costs showed that this coefficient was by 2.6 times lower in case of using standard IFN-? in case of both an increase of the cost of this drug by 25%, and in a decrease of the cost of PegIFN-? by 25%. Conclusion. Treatment of CHC caused by genotype 1 virus, with low viral load and minimal fibrosis by standard IFN-?2b in combination with ribavirin does not have a lesser cost-effectiveness than treatment with PegIFN-?2а together with ribavirin. The key prognostic factors determining the appropriateness of continuing therapy with standard IFN-? is RVR. In this cohort of patients, a significant economic benefit of cost-effectiveness of standard IFN-?2b was established.