Cost-effectiveness analysis of lamivudine and adefovir dipivoxil in the treatment of patients with HBeAg-negative chronic hepatitis B.
OBJECTIVE
To estimate the cost-effectiveness over a 4-year duration of lamivudine and adefovir dipivoxil for patients with hepatitis B 'e' antigen-negative chronic hepatitis B.


METHODS
A decision analysis model has been used to perform a cost-effectiveness analysis of lamivudine and adefovir dipivoxil from the perspective of the Spanish Public Health System. Data were obtained from clinical trials.


RESULTS
For the base-case, the total estimated cost per patient treated with lamivudine or adefovir dipivoxil for 4 years was 11,457 and 21,939 respectively. Virological response at year 4 for the lamivudine arm was 40.4% and 78.0% for the adefovir dipivoxil arm. The average cost-effectiveness ratio (cost per responding patient at year 4) was 28,375 for the lamivudine arm and 28,132 for the adefovir dipivoxil arm. The incremental cost-effectiveness ratio of adefovir dipivoxil vs. lamivudine (cost per additional responding patient with adefovir dipivoxil) was 27,872, demonstrating that this cost was slightly lower than the average cost-effectiveness ratios of adefovir dipivoxil or lamivudine. The sensitivity analysis demonstrated that the factors that most influence the cost-effectiveness were the response to adefovir dipivoxil and lamivudine at year 4.


CONCLUSIONS
Long-term treatment with adefovir dipivoxil is a cost-effective strategy in patients with chronic hepatitis B 'e' antigen-negative hepatitis.
Buti
M
M
Department of Hepatology, Hospital Vall d'Hebrón, Barcelona, Spain. mbuti@vhebron.net
Casado
M A
MA
Calleja
J L
JL
Salmerón
J
J
Aguilar
J
J
Rueda
M
M
Esteban
R
R
D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D063065:Organophosphonates / Q000191:economics* / Q000627:therapeutic use; D013030:Spain
D019380:Anti-HIV Agents; D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil