A cost-effectiveness analysis of currently approved treatments for HBeAg-positive chronic hepatitis B.
BACKGROUND
A variety of pharmaceuticals are currently approved for the treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB), but their relative economic value is unclear. The goal of this analysis was to compare the cost effectiveness of adefovir, entecavir, lamivudine, pegylated interferon and telbivudine.


METHODS
We conducted a cost-utility analysis from a US payer perspective over a lifetime time horizon using a Markov model, in a hypothetical population with HBeAg-positive CHB and a mean age of 35 years. Disease progression probabilities, costs and quality-of-life data were derived from the literature. We assumed a treatment duration of 4 years, with the use of combination therapy for drug resistance. Nonresponders to pegylated interferon were assumed to receive entecavir in years 3-4. Sensitivity analyses, including probabilistic sensitivity analysis, were conducted to evaluate uncertainty in the results. All costs were valued in $US, year 2008 values. Costs and outcomes were discounted at 3% per annum.


RESULTS
The 10-year cumulative incidence of cirrhosis for no treatment was 26.1%, and ranged from 19.7% to 23.8% with treatment; undiscounted life-years were 36.2 for no treatment, or ranged from 36.82 to 37.54 with treatment. Initiation with entecavir (18.70 QALYs) and pegylated interferon (18.64 QALYs) provided the largest treatment benefits overall, followed by telbivudine (18.55 QALYs). The probabilities of the interventions being cost effective at a threshold of USD 50,000 per QALY were 57%, 37% and 2% for initiation with entecavir, pegylated interferon and telbivudine, respectively. The results were dependent on baseline seroconversion rate and the effect of viral suppression on cirrhosis risk.


CONCLUSIONS
Initiation of treatments for HBeAg-positive CHB with a favourable combination of seroconversion, viral suppression and resistance profile appear to offer the greatest clinical and economic value.
Spackman
D Eldon
DE
Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Washington, USA.
Veenstra
David L
DL
D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D024882:Drug Resistance, Viral; D006513:Hepatitis B e Antigens / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000517:prevention & control; D008390:Markov Chains; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014481:United States
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens