Cost-effectiveness of interferon-alpha 2b treatment for hepatitis B e antigen-positive chronic hepatitis B.
OBJECTIVE
To estimate the cost-effectiveness of interferon-alpha 2B for the treatment of patients with chronic hepatitis B infection who are positive for hepatitis B e antigen (HBeAg).


METHODS
Meta-analysis of nine randomized controlled trials and cost-effectiveness analysis, projecting the clinical and economic outcomes expected from changes in serologic markers of hepatitis B viral replication.


METHODS
MEDLINE search, expert panel opinion, hospital cost data, and adjusted physician charges.


METHODS
552 patients with confirmed chronic hepatitis B infection who were positive for HBeAg.


METHODS
Interferon-alpha 2b.


METHODS
Lifetime incidence of cirrhosis and hepatocellular carcinoma; life expectancy; quality-adjusted life expectancy; and costs and marginal cost-effectiveness ratios from a societal perspective.


RESULTS
Interferon-alpha 2b increases the likelihood of becoming negative for HBeAg from 9.1% to 45.6% (difference, 36.5%; 95% CI, 23.7% to 49.2%) and of becoming negative for hepatitis B surface antigen from 1.7% to 7.7% (difference, 6.0%; CI, 2.8% to 9.3%) in the first year. For a 35-year-old person with chronic hepatitis B who is HBeAg positive, our analysis suggests that interferon-alpha 2b will increase life expectancy by 3.1 years or 3.4 quality-adjusted life-years and will decrease projected lifetime costs, even if future savings are discounted; thus, interferon-alpha 2b is the dominant strategy. Even with the model biased strongly in favor of standard care, the marginal cost-effectiveness ratio of interferon did not exceed $12,000 per life-year gained.


CONCLUSIONS
Interferon-alpha 2b should prolong life and lower costs for patients with chronic hepatitis B who are HBeAg positive.
Wong
J B
JB
New England Medical Center, Boston, Massachusetts, USA.
Koff
R S
RS
Tinè
F
F
Pauker
S G
SG
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000276:immunology / Q000628:therapy*; D006513:Hepatitis B e Antigens / Q000032:analysis*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics* / Q000627:therapeutic use*; D008017:Life Expectancy; D008103:Liver Cirrhosis / Q000209:etiology; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011994:Recombinant Proteins; D012680:Sensitivity and Specificity
D006513:Hepatitis B e Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins