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October 15, 2003

Cost-effectiveness of Treatment for Chronic Hepatitis C Infection

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(15):1993-1994. doi:10.1001/jama.290.15.1993-a

In Reply: We agree with Dr Bernstein that conclusions regarding the cost-effectiveness of early treatment for asymptomatic patients with chronic HCV infection must be extrapolated cautiously. Among patients without fibrosis, however, our findings are robust with respect to age—we found that mean cost-effectiveness ratios for combination therapy with pegylated interferon would be only 8.3% higher than baseline ratios for patients aged 30 years, or 1.5% lower for patients aged 50 years. Our main objective was to investigate the cost-effectiveness of treatment in patients with no fibrosis precisely because this population differs from target populations in previous studies and, as Bernstein notes, consensus recommendations remain uncertain about how such patients should be treated.1 Although the cohort in our analysis may not exemplify the typical treatment candidate today, we expect patients without fibrosis to represent a growing proportion of candidates as more aggressive efforts aim to identify undiagnosed seropositive individuals.