Low dose interferon alpha affects quality of life and may not be cost-effective

A randomised trial suggests that low-dose extended duration adjuvant interferon alpha-2a significantly affects quality of life, as shown by validated scales, and is unlikely to be cost effective in the UK setting.Over 6000 patients have been entered into trials of interferon therapy for malignant melanoma.A recent study of low-dose extended duration adjuvant in patients with thick primary cutaneous melanoma showed no significant difference in overall or recurrence-free survival up to five years. The aim of this report was to analyse the quality of life and economic aspects of that trial.The trial included 674 patients who were randomised to interferon alpha-2a, three times a week for two years or until recurrence, or to placebo (338 and 336 patients respectively). Sixty six percent of patients had valid baseline quality of life data. Patients' characteristics were similar in those with or without QoL baseline data.Results showed that the observation group had significantly better quality of life using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 scales of role, emotional, cognitive and social functioning, and global health status. The interferon group had significantly worse symptom scores on the V1 symptom scales for fatigue, nausea/vomiting, dyspnoea, appetite loss, constipation and diarrhoea.Economic analysis showed that costs were #3066 higher in the interferon group, giving an incremental cost per quality-adjusted life year of #41 432 at five years. The authors discussed the differences between their results and previous studies of high dose interferon, which had used utility analysis and had suggested that interferon may be cost effective. The utility-based studies showed that a decrease in QoL during interferon treatment was more than offset by improved QoL because of reduced recurrence and reduced mortality. The authors noted that few studies have used validated quality of life measures. They had used different regimes of interferon, and different methods of analysis, so quality of life, survival and recurrence might be expected to differ. The authors concluded that interferon had significant effects on QoL and symptoms, and that it would not be likely to be cost-effective in this setting.Reference...