The cost-effectiveness of alternative therapeutic strategies for the management of chronic hepatitis B in Poland.
OBJECTIVE
The aim of the study was to estimate the cost-effectiveness of alternative therapeutic strategies for the management of chronic hepatitis B (CHB) in Poland.


METHODS
The model for the Polish health-care context was based on clinical data from the literature and local data on health-care resource utilization and unit costs. Costs and effects of a population of CHB patients were modeled using four scenarios, which attempt to reflect real-life practice in which patients may receive any of the treatment options available and in which a proportion of patients may still receive no treatment because therapy is not suitable. Strategies A and B assumed the availability of both treatment options: the first choice of treatment is in A, lamivudine, and in B, interferon alpha (IFN-alpha). In strategy C, the only approved treatment is IFN-alpha, and in strategy D, the patients receive no antiviral treatment. The outcome measures were HBeAg seroconversion and nonprogression to cirrhosis-the surrogate marker with predictive value for improved survival. Only direct medical costs were analyzed. The payer's perspective and time horizon of 1 year were adopted. One-way sensitivity analysis and extreme scenario analysis were performed.


RESULTS
The best results in terms of seroconversion and nonprogression to cirrhosis were achieved for strategy A, costs were lowest for strategy D, and strategies B and C were dominated by strategy A. The incremental cost/effectiveness ratio (ICER) comparing strategy A with strategy D was 57,855 Polish new zloty (PLN) per extra seroconversion and 79,550 PLN per cirrhosis case avoided.


CONCLUSIONS
Cirrhosis reduces estimated life expectancy by 37.76 years and by 20 years among 30- and 50-year-olds, respectively. The ICER for strategies A and D was 2105 PLN and 3978 PLN per life-years gained for the population at ages 30 and 50, respectively, and was below the suggested threshold for cost-effectiveness, based on treatment costs for 1 year of hemodialysis in Poland (62,400 PLN). Changing the value of key drivers for sensitivity analysis did not have a significant effect on the ICER.
Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, ul. Kremowa 13, 02-969 Warsaw, Poland. ewaorlewska@go2.pl
Ewa
E
Orlewska
D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000379:methods; D003663:Decision Trees; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D018450:Disease Progression; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D016898:Interferon-alpha / Q000191:economics* / Q000627:therapeutic use; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D015233:Models, Statistical; D011044:Poland; D016896:Treatment Outcome
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D016898:Interferon-alpha; D019259:Lamivudine