Pretreatment Evaluation of Chronic Hepatitis C

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Abstract
CHRONIC HEPATITIS C virus (HCV) infection affects nearly 4 million people in the United States, accounting for 40% of all chronic liver disease, 20% to 30% of all liver transplantations, and more than 8000 deaths annually.1,2 Until recently, interferon alfa-2b had been approved for a single 6-month course of treatment for chronic hepatitis C (CHC). Nonetheless, physicians, patients, and third-party payers have been reluctant to initiate treatment because of the low likelihood of long-term response following treatment, the slowly progressive nature of CHC, and the cost of interferon. However, we and others recently demonstrated that the marginal cost-effectiveness of treating patients with biopsy-proven mild CHC for 6 to 12 months ($1200 to $5000 per year of life gained) compares favorably with many other well-accepted conventional therapies.3,4 However, even further cost efficiencies might accrue by either reducing pretreatment evaluation costs or using pretreatment evaluations to identify and target therapy to patients having higher probabilities of long-term response. To quantify the benefit of testing, we compared alternative pretreatment management strategies based on their predicted lifelong clinical and economic outcomes.

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