Treating Anemia and Neutropenia With Growth Factors

Two commonly reported hematologic toxicities of HCV treatment—anemia and neutropenia—can be managed with growth factors or by dose reductions in ribavirin (for anemia) or pegylated interferon (for neutropenia). Dose reduction may compromise efficacy of therapy, however, and anemia may become treatment limiting, particularly for HIV-positive patients. Growth factors are extremely expensive; a month’s supply of treatment for anemia or neutropenia costs about $8,000. Some State ADAPs cover growth factors, and they may be accessible through patient assistance programs (see Resources section).

Despite the price of HCV treatment and growth factors, treating HCV with pegylated interferon and ribavirin may be cost-effective in HIV/HCV coinfection. Two recent models from Wong and colleagues assessed the economic value of HCV treatment in HIV/HCV coinfection; the researchers based their calculations on the costs of treatment in Spain and the United States.161,162 HCV treatment was determined to be cost-effective in people with a Metavir biopsy score of F2, indicating moderate liver disease, and a CD4 cell count of more than 200/mL. The cost-effectiveness of treatment increased for coinfected patients with a CD4 cell count of more than 350/mL because their risk for developing serious liver disease increased with longer life expectancy. The authors of the studies assumed that HCV treatment would be discontinued at Week 12 in the event of virological nonresponse. In the U.S. study, the cost of growth factors was included in the analysis; nonetheless, treatment was still considered cost-effective.