Hepatitis C virus (HCV) identification is relatively recent (1989)  and many efforts were made in the last years to optimize its pharmacological treatment and disease detection rates.
HCV infection becomes chronic in approximately 75%–85% of cases, significantly raising healthcare costs, especially those resulting from hospital bills. According to Wong et al., infection with hepatitis C virus is the leading cause in approximately 30% of liver transplantation, 40% of cases of decompensated cirrhosis and 60% of hepatocellular carcinoma . Sustained virological response (SVR) in chronic hepatitis C is associated with better prognosis, since observed reduction in clinical events, mainly liver failure is observed when SVR is achieved .
In 2010, Brazilian Ministry of Health published information on anti-HCV (antibody to the hepatitis C virus, its presence indicates an active or chronic hepatitis C infection) prevalence in Brazilian capital cities; estimated anti-HCV prevalence was 2.1% in North Region, 0.7% in Northeast Region, 1.3% in Central-West Region, 1.3% in Southeast Region and 1.2% in South Region . A total of 60,908 cases of hepatitis C were confirmed and registered in Brazil from 1999 to 2009 according to 2010 Viral Hepatitis Epidemiological Bulletin .
According to Brazilian Ministry of Health, in 2011, expenses with Hepatitis C achieved around $Brz 17.7 million . Moreover, disease’s chronic nature and its successive stages, such as cirrhosis, hepatocellular carcinoma or liver transplantation and negative issues produced by disease, such as absenteeism, early retirement, loss of productivity, aggravate social and economic burden related to HCV infection. In this scenario, the adoption of cost-effective strategies would beneficiate health policy makers, society and patients.
In the Public Healthcare System of Brazil (SUS), according to the therapeutic guidelines and clinical protocols for hepatitis C , patients with genotype 1 aged from 18 to 70 years old, with platelet counts > 90,000/mm3 (non cirrhotic) or > 75,000/mm3 (cirrhotic) after qualitative PCR (Polymerase Chain Reaction), should be treated with pegylated interferon alfa-2a or 2b weekly and ribavirin 15 mg/kg daily for 48-72-week treatment period. Patients with genotypes 2 or 3, in the absence of low SVR predictors – METAVIR score ≥ F3 or clinical manifestations of cirrhotic fibrosis or viral load > 600,000 UI/mL –, should be treated with conventional interferon alfa-2a or 2b, 3 times a week and ribavirin 15 mg/kg daily for 24-week treatment period; in the presence of low SVR predictors, patients should be treated with pegylated interferon alfa-2a or 2b weekly and ribavirin 15 mg/kg daily for 24-48-week treatment period. The guideline doesn’t mention any differences between efficacies of both pegylated interferons. However, literature has been discussing the clinical superiority of one of them, with the tendency to peginterferon-alfa-2a [8–13]. Economic assessment comparing peginterferon-alfa-2a and peginterferon-alfa-2b in Chronic Hepatitis C indicates that the first one was considered cost-effective or even dominant in several countries like: USA, UK, Spain, Poland and Mexico [14–20].
The objective of this analysis was to assess the cost-effectiveness ratio of peginterferon-alfa-2a versus peginterferon-alfa-2b both plus ribavirin (RBV), in a 24-week therapeutic schedule in the treatment of patients with chronic hepatitis C, genotypes 2 and 3 or 48-week schedule for genotype 1, from the perspective of the Public Health Care System in Brazil. In order to obtain efficacy data for the analysis, our aim was also to conduct a systematic review of RCTs and perform a meta-analysis of the results.