OBJECTIVES: To document real-world utilization patterns and costs of peginterferon plus ribavirin combination therapy in the management of chronic hepatitis C virus (C-HCV) in Europe.
METHODS: Patient charts from clinics in the UK, France, Germany, Spain, and Italy were retrospectively reviewed by 240 physicians (∼48 per country). Patient inclusion criteria were: C-HCV diagnosis within past 5 years; treated with peginterferon alfa-2a or alfa-2b plus ribavirin combination therapy (PEG2A+R or PEG2B+R, respectively); age ≥18 years; no diagnoses of hepatitis B or HIV/AIDS; ≥1 year follow-up post-treatment initiation; no clinical trial participation. Treatment dosing, duration, compliance, and costs (in 2009 3) were descriptively analyzed at the patient level. Published drug prices were used in all cost calculations.
RESULTS: Hepatology, gastroenterology, and internal medicine were the predominant physician specialties observed, representing 22%, 30%, and 25%, respectively, of all physicians recruited. A total of 804 patients (∼160 per country) were identified, of whom 65% were male with mean age of 46 years. More patients initiated PEG2A+R (69%) than PEG2B+R (31%). For both regimens, all major ribavirin doses (800, 1000, and 1200 mg) were seen, representing 36%, 35%, and 22%, respectively, of PEG2A+R patients and 39%, 47%, and 14%, respectively, of PEG2B+R patients. Mean treatment duration was ∼35 weeks for both PEG2A+R and PEG2B+R, with distribution spikes at 24 and 48 weeks. Treatment compliance was relatively high, with ∼75% of patients completing therapy as planned regardless of regimen. Mean weekly treatment costs ranged from 3280 to 3350 depending on the ribavirin dose. Mean total regimen costs were estimated at 311,827 and 311,109 per patient for PEG2A+R and PEG2B+R, respectively.
CONCLUSIONS: Peginterferon-based regimens, although a mainstay of C-HCV management, are costly. Public health systems bearing the high economic burden of C-HCV treatment should be mindful of these costs when considering formulary access for alternative treatments.
