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To the Editor: Dr Wong and colleagues1 examined the cost-effectiveness of management strategies for patients with chronic hepatitis C, and the authors concluded that a 12-week initial empirical trial of interferon alfa-2b is a "reasonable management strategy." Given a purported prevalence of some 4 million people in the United States infected with hepatitis C, of whom a significant number may have chronic hepatitis and be candidates for therapy, this is not a trivial recommendation.
Like many readers, I understand the concept and importance of cost-effectiveness analysis but lack the knowledge, time, and energy to carefully analyze the strategies used by authors in performing the analysis. Of particular importance are the various assumptions that need to be made regarding outcomes at different stages. In the article by Wong et al, results of 3 retrospective studies were pooled to obtain the natural history of hepatitis C, and an expert panel of hepatologists was used to assess utilities for different health states.
This may have been done very objectively, but when I see that the study was funded by the very drug company that makes and markets interferon (and ribavirin) for treatment of hepatitis C, I have serious ethical concerns. It is difficult enough to digest intervention trials of specific drugs funded by that drug's manufacturer, but to be asked to evaluate a cost-effectiveness study funded by the same drug company whose drug is being analyzed severely strains reasonable ethical bounds. I strongly feel that journals should not support the publication of cost-effectiveness studies funded in this manner. There seem to be too many assumptions that may be influenced, consciously or unconsciously, by the funding source and much too great a disparity between the reader's ability to assess the study methods and the researchers' ability to perform the analysis. If hepatitis C is such an important issue (which I can certainly see it might be), a government agency or other nonprofit entity should fund the cost-effectiveness study.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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