Journal of Hepatology
Volume 51, Issue 4 , Pages 640-646, October 2009

Modeling the cost-effectiveness of different oral antiviral therapies in patients with chronic hepatitis B

  • Maria Buti

      Affiliations

    • Servicio de Hepatologı´a, Hospital Vall d’Hebrón and Ciber-ehd del Instituto Carlos III, Barcelona, Spain
    • Corresponding Author InformationCorresponding author. Tel.: +34 93 2746140; fax: +34 93 2746068.
  • ,
  • Max Brosa

      Affiliations

    • Oblikue Consulting, Barcelona, Spain
  • ,
  • Miguel A. Casado

      Affiliations

    • Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
  • ,
  • Magdalena Rueda

      Affiliations

    • Gilead Sciences Inc., Madrid, Spain
  • ,
  • Rafael Esteban

      Affiliations

    • Servicio de Hepatologı´a, Hospital Vall d’Hebrón and Ciber-ehd del Instituto Carlos III, Barcelona, Spain

Received 19 January 2009; received in revised form 16 March 2009; accepted 1 April 2009. published online 20 May 2009.

Associate Editor: R.P. Perrillo

Background/Aims

Chronic hepatitis B (CHB) is a common disease associated with high morbidity, mortality and impact on healthcare costs. Several oral antiviral therapies can lead to complete virologic response, which is associated with prevention of disease progression.

The aim of this study was to estimate the cost-effectiveness of the oral antiviral treatments lamivudine, adefovir, telbivudine, entecavir and tenofovir, in patients with CHB.

Methods

A Markov model was used to project the lifetime complications and costs in cohorts of both HBeAg-positive and HBeAg-negative CHB patients treated with one of the above drugs or no treatment. Rescue therapy with two different combination therapies (adefovir plus lamivudine or tenofovir plus entecavir) with their corresponding costs and efficacy rates was also considered. The probabilities of disease progression were based on serum HBV DNA levels. Disease and complication costs were assessed using the perspective of the Spanish National Health System.

Results

The highest rate of virologic response was obtained with tenofovir, and this translated to its higher life years saved (LYS) and quality adjusted life years (QALY) compared with the rest of the alternatives in HBeAg-positive and HBeAg-negative patients. Tenofovir is associated with lower costs and higher efficacy over entecavir, telbivudine and adefovir in HBeAg-positive patients, and telbivudine and entecavir in HBeAg-negative patients. The incremental cost-effectiveness ratios with respect to the rest of the alternatives are below the common reference efficiency threshold of 30,000€ per LYS/QALY.

Conclusion

In chronic HBV infected patients, tenofovir is a cost-effective or even cost-saving strategy compared with other available treatment options for CHB.

Abbreviations: CHB, chronic hepatitis B, HBV, chronic hepatitis B virus, HCC, hepatocellular carcinoma, LYS, life year saved, QALY, quality-adjusted life years, HBsAg, hepatitis B surface antigen, HBeAg, hepatitis B antigen, ICER, incremental cost-effectiveness ratio, MET, most efficacious treatment, PCR, polymerase chain reaction, AASLD, American Association for the Study of Liver Diseases, EASL, European Association for the Study of the Liver, APASL, Asian Pacific Association for the Study of the Liver

Keywords: Chronic hepatitis B, Cost-effectiveness analysis, Oral antiviral therapy

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 This study was supported in part by a research grant from Gilead Sciences. The authors had independence from the funding company in study design, analysis and interpretation of the data, report writing, and publication, regardless of the results. M. Brosa is an employee of Oblikue Consulting; M.C. is an employee of Pharmaeconomics & Outcomes Research Iberia; M.R. is an employee of Gilead Sciences Inc.; M. Buti, M. Brosa and R. Esteban are on the Advisory board for Gilead, Novartis. Speaker: Gilead, Novartis, Bristol-Myers Squibb and Schering-Plough.

PII: S0168-8278(09)00322-5

doi:10.1016/j.jhep.2009.04.013

Refers to article:

  • Cost-effectiveness of oral treatments for chronic hepatitis B , 06 August 2009

    Geoffrey M. Dusheiko
    Journal of Hepatology October 2009 (Vol. 51, Issue 4, Pages 623-625)

Journal of Hepatology
Volume 51, Issue 4 , Pages 640-646, October 2009