Cost-effectiveness of peginterferon alpha-2a compared with lamivudine treatment in patients with HBe-antigen-positive chronic hepatitis B in the United Kingdom.
BACKGROUND
Peginterferon alpha-2a (40 kDa), a new treatment for chronic hepatitis B, produces seroconversion within 48 weeks in approximately 32% of HBeAg-positive patients. Over a defined treatment duration it offers improved efficacy over lamivudine, but at higher cost. We assessed the clinical outcomes and costs, from the perspective of the UK National Health Service, of 48 weeks of peginterferon alpha-2a (40 kDa) vs. 4 years of lamivudine.


METHODS
Cost-effectiveness was analysed using a state-transition Markov model simulating HBeAg-positive chronic hepatitis B natural history. Efficacy data were obtained from a large randomized trial comparing peginterferon alpha-2a (40 kDa) with lamivudine over 48 weeks. Use of adefovir salvage treatment for lamivudine-resistant patients was also evaluated. Long-term lamivudine efficacy, treatment durability, disease progression, cost, and quality-of-life estimates were derived from the literature. One-way and probabilistic sensitivity analyses evaluated uncertainty.


RESULTS
Treatment with peginterferon alpha-2a (40 kDa) for 48 weeks resulted in higher discounted total healthcare costs ( pound 3100), but an increase of 0.3 discounted quality-adjusted life years compared with long-term lamivudine, giving an incremental cost-effectiveness ratio of pound 10,400 per quality-adjusted life year gained ( pound 8300- pound 15,400 in one-way sensitivity analyses). The cost-effectiveness acceptability curve showed intervention was below the pound 30,000/QALY threshold in over 95% of the simulations. When adefovir was included for patients with lamivudine resistance, peginterferon alpha-2a (40 kDa) had an incremental cost of pound 6100/QALY gained.


CONCLUSIONS
Treatment with peginterferon alpha-2a (40 kDa) for a defined duration of 48 weeks, although more expensive than lamivudine therapy, provides improvement in health outcomes, with a cost-effectiveness ratio well below the current UK cost-effectiveness threshold.
Veenstra
David L
DL
University of Washington, Seattle, Washington 98195, USA. veenstra@u.washington.edu
Sullivan
Sean D
SD
Dusheiko
Geoffry M
GM
Jacobs
Michael
M
Aledort
Julia E
JE
Lewis
Gavin
G
Patel
Kavita K
KK
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D019259:Lamivudine / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D017059:Models, Econometric; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D011994:Recombinant Proteins; D012680:Sensitivity and Specificity; D006113:United Kingdom
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D019259:Lamivudine; D011092:Polyethylene Glycols; C100416:peginterferon alfa-2a