Cost-effectiveness of peginterferon alpha-2a compared to lamivudine treatment in patients with hepatitis B e antigen positive chronic hepatitis B in Taiwan.
BACKGROUND
Peginterferon alpha-2a (40KD), a new treatment option for patients with chronic hepatitis B (CHB), offers improved efficacy with a defined treatment duration compared with lamivudine, but at a higher cost. We undertook an economic evaluation of peginterferon alpha-2a from the perspective of the Taiwan Bureau of National Health Insurance to assess the clinical outcomes and costs of 48 weeks of peginterferon alpha-2a for the treatment of patients with hepatitis B e antigen (HBeAg)-positive CHB, compared to lamivudine treatment for 48 weeks.


METHODS
We performed a cost-effectiveness analysis using a state-transition Markov model simulating the natural history of HBeAg-positive CHB. Efficacy data were obtained from a randomized clinical trial of 820 patients (87% were Asian) comparing peginterferon alpha-2a to lamivudine. We modeled a hypothetical cohort of 32-year-old patients with HBeAg-positive CHB. Life expectancy, quality-adjusted life expectancy, lifetime costs ($NTD) and incremental cost-effectiveness ratios (ICER) were estimated. One-way sensitivity analyses were performed on all parameters in the model to evaluate uncertainty.


RESULTS
Treatment with peginterferon alpha-2a compared to lamivudine resulted in higher total costs, but longer quality-adjusted life expectancy, yielding an ICER of $NTD 381 000 ($US 12,000) per quality-adjusted life year (QALY) gained. Although there is uncertainty associated with the prognosis of HBeAg-positive CHB, the ICER did not exceed $NTD 485,000 ($US 15,000) per QALY gained despite variation in the parameters used in the analysis.


CONCLUSIONS
Our analysis suggests that 48-week treatment with peginterferon alpha-2a compared to 48-week treatment with lamivudine in HBeAg-positive patients offers life expectancy and quality of life benefits at a favorable cost-effectiveness ratio.
Sullivan
Sean D
SD
University of Washington, Seattle, Washington 98195, USA. sdsull@u.washington.edu
Veenstra
David L
DL
Chen
Pei-Jer
PJ
Chang
Ting-Tsung
TT
Chuang
Wan-Long
WL
Tsai
Chiaming
C
Patel
Kavita
K
D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics* / Q000627:therapeutic use; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D011092:Polyethylene Glycols / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D011994:Recombinant Proteins; D013624:Taiwan / Q000453:epidemiology
D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D019259:Lamivudine; D011092:Polyethylene Glycols; C100416:peginterferon alfa-2a