Cost-effectiveness of treatment for hepatitis C in an urban cohort co-infected with HIV

Am J Med. 2007 Mar;120(3):272-9. doi: 10.1016/j.amjmed.2006.06.036.


Purpose: Recent clinical trials have evaluated treatment strategies for chronic infection with hepatitis C virus (HCV) in patients co-infected with human immunodeficiency virus (HIV). Our objective was to use these data to examine the cost-effectiveness of treating HCV in an urban cohort of co-infected patients.

Methods: A computer-based model, together with available published data, was used to estimate lifetime costs (2004 US dollars), life expectancy, and incremental cost per year of life saved (YLS) associated with 3 treatment strategies: (1) interferon-alfa and ribavirin; (2) pegylated interferon-alfa; and (3) pegylated interferon-alfa and ribavirin. The target population included treatment-eligible patients, based on an actual urban cohort of HIV-HCV co-infected subjects, with a mean age of 44 years, of whom 66% had genotype 1 HCV, 16% had cirrhosis, and 98% had CD4 cell counts >200 cells/mm3.

Results: Pegylated interferon-alfa and ribavirin was consistently more effective and cost-effective than other treatment strategies, particularly in patients with non-genotype 1 HCV. For patients with CD4 counts between 200 and 500 cells/mm3, survival benefits ranged from 5 to 11 months, and incremental cost-effectiveness ratios were consistently less than $75,000 per YLS for men and women of both genotypes. Due to better treatment efficacy in non-genotype 1 HCV patients, this group experienced greater life expectancy gains and lower incremental cost-effectiveness ratios.

Conclusions: Combination therapy with pegylated interferon-alfa and ribavirin for HCV in eligible co-infected patients with stable HIV disease provides substantial life-expectancy benefits and appears to be cost-effective. Overcoming barriers to HCV treatment eligibility among urban co-infected patients remains a critical priority.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / economics*
  • AIDS-Related Opportunistic Infections / mortality
  • Adult
  • Antiretroviral Therapy, Highly Active / economics
  • Antiviral Agents / economics*
  • Antiviral Agents / therapeutic use
  • Cohort Studies
  • Cost of Illness*
  • Cost-Benefit Analysis
  • Female
  • Follow-Up Studies
  • Hepatitis C, Chronic / diagnosis
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / economics*
  • Hepatitis C, Chronic / mortality
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / economics
  • Interferon-alpha / therapeutic use
  • Male
  • Markov Chains
  • Middle Aged
  • Recombinant Proteins
  • Ribavirin / economics
  • Ribavirin / therapeutic use
  • Survival Analysis
  • Treatment Outcome
  • United States
  • Urban Health


  • Antiviral Agents
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins
  • Ribavirin