Economic evaluation of chronic hepatitis B treatments in Taiwan.
OBJECTIVE
Chronic hepatitis B (CHB) and its sequelae are major health problems in Taiwan. The purpose of the present study was the economic evaluation of short-duration treatments of CHB and longer duration antiviral treatment for up to 5 years.


METHODS
Ten-health state CHB disease progression Markov models were used for hepatitis B e antigen (HBeAg)-positive and HBeAg-negative CHB patients, respectively, that included the emergence of antiviral resistance. The perspective of this economic evaluation was the Taiwan health-care system. Costs and benefits were discounted at 3% per annum.


RESULTS
Short-course therapies of up to 1-year treatment had limited impact on improving patient survival. Long-term viral suppression with lamivudine and adefovir sequential rescue therapies (including add-on therapies) for up to 5 years were found to be highly cost-effective by international standards (estimated to be NT$580,000 per quality adjusted life year [QALY] for Taiwan). When Taiwan-specific model inputs were used for HBeAg-positive CHB, the cost per QALY for lamivudine plus adefovir sequential antiviral therapy increased by approximately 100% over the base-case estimate, but was still well within the estimated NT$580,000 per QALY threshold.


CONCLUSIONS
In Taiwan, treatment of CHB patients with lamivudine and adefovir sequential antiviral therapies for up to 5 years results in survival benefits and is highly cost-effective.
Lacey
Laurence
L
LaceySolutions Ltd, Dublin, Ireland. larryflacey@utvinternet.com
Chien
Rong-Nan
RN
Chuang
Wan-Long
WL
Pwu
Raoh-Fang
RF
D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D063065:Organophosphonates / Q000191:economics* / Q000627:therapeutic use*; D013624:Taiwan; D013997:Time Factors
D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; C053001:adefovir; D000225:Adenine