The objective of this appraisal is to compare the use of peginterferon therapy (in combination with ribavirin or as monotherapy) in mild chronic hepatitis C with the current practice of deferring treatment until the disease has progressed to moderate or severe. Current practice and the technology are described in section 2.
Peginterferon alfa-2a (Pegasys) and ribavirin (Copegus) are manufactured by Roche. For genotypes 2 and 3, the licensed regimen is peginterferon alfa-2a 180 micrograms once per week plus ribavirin 800 mg/dayfor 24 weeks. This course of therapy costs £5,019 (excluding VAT; BNF50). For genotypes 1, 4, 5 and 6, the regimen is peginterferon alfa-2a 180 micrograms once per week for 48 weeks plus ribavirin 1,000 mg/day (for people weighing less than 75 kg) or 1,200 mg/day (for those weighing 75 kg or more) for the same length of time as peginterferon alfa. The cost is £10,963 or £11,889 for 48 weeks depending on body weight. For peginterferon monotherapy, the cost of treatment is £6,339 (for 12 months) for all genotypes.
Peginterferon alfa-2b (ViraferonPeg) and ribavirin (Rebetol) are produced by Schering-Plough. For genotypes 2 and 3, the licensed regimen is peginterferon alfa-2b 1.5 micrograms/kg/week plus ribavirin 800 mg/day (for people weighing less than 65 kg) or 1,000 mg/day (for those weighing 65 to 85 kg) or 1,200 mg/day (for those weighing more than 85 kg) for 24 weeks. The cost of a course is £6,734 for a person of an average weight of 79 kg (excluding VAT; BNF50). Costs may vary in different settings because of negotiated procurement discounts.
The marketing authorisation for peginterferon alfa-2b in combination with ribavirin has been varied and now allows for 24 weeks of treatment in people with genotype 1 (low viral load) who have responded sufficiently to treatment at 4 weeks. The cost is £6,734 for a person of average weight (79 kg). For people with genotype 1 (high viral load) and optionally for those with low viral load, the cost for 48 weeks of treatment is £13,468 for a person of average weight (excluding VAT; BNF50). Costs may vary in different settings because of negotiated procurement discounts.
For genotypes 5 and 6, the regimen (and associated cost) is as for genotypes 1 and 4 (high viral load). Costs may vary in different settings because of negotiated procurement discounts.
The cost of treatment for 24 weeks with peginterferon alfa-2b monotherapy is £1,657 (0.5 micrograms/kg/week) or £2,652 (1.0 micrograms/kg/week) and for 48 weeks is £3,314 (0.5 micrograms/kg/week) or £5,303 (1.0 micrograms/kg/week; excluding VAT; BNF50). Costs may vary in different settings because of negotiated procurement discounts.