Economic evaluation of lamivudine compared with interferon-alpha in the treatment of chronic hepatitis B in the United States.
OBJECTIVE
To determine whether lamivudine or interferon-alpha (IFN-alpha) is the more successful treatment for chronic hepatitis B given a fixed drug budget.


METHODS
A decision-tree model of 1 year.


METHODS
Average wholesale prices were used to estimate drug costs. A fixed drug budget of $558,910, sufficient to treat 100 patients with IFN-alpha, was assumed. Clinical data were taken from randomized controlled trials. The outcome measures used were hepatitis B "e" antigen (HBeAg) seroconversion rates and rates of progression to cirrhosis.


RESULTS
The analysis showed that given the fixed drug budget, 353 patients could be treated with lamivudine, resulting in an expected 62 HBeAg seroconversions, with 6 patients progressing to cirrhosis. Given the same drug budget, 100 patients could be treated with IFN-alpha, leaving 253 patients untreated. This treatment scenario would result in an expected 32 HBeAg seroconversions, with 28 patients progressing to cirrhosis. Compared with no treatment, the costs per additional HBeAg seroconversion obtained were $12,703 for lamivudine and $39,922 for IFN-alpha. In addition, each case of cirrhosis avoided through lamivudine treatment resulted in significant annual cost savings. Lamivudine therapy also provided additional clinical benefits (e.g., normalization of alanine transaminase levels, reduction in hepatitis B virus DNA levels, improvement in liver histology) to patients who do not seroconvert.


CONCLUSIONS
From the perspective of a third-party payer with a fixed drug budget, lamivudine is more cost-effective therapy than IFN-alpha for the treatment of chronic hepatitis B.
Brooks
E A
EA
PPD Development, Research Triangle Park, NC, USA.
Lacey
L F
LF
Payne
S L
SL
Miller
D W
DW
D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D002017:Budgets; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D018450:Disease Progression; D016527:Drug Costs / Q000706:statistics & numerical data; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D016898:Interferon-alpha / Q000191:economics* / Q000627:therapeutic use*; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology; D014481:United States
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D016898:Interferon-alpha; D019259:Lamivudine