[Analysis of the cost-effectiveness of antiviral therapies in chronic hepatitis B patients in Korea].
OBJECTIVE
The purpose of this study was to evaluate the cost-effectiveness of 1 year and up to 5 years of antiviral treatment for chronic hepatitis B (CHB).


METHODS
Two ten-health-state Markov models were developed for CHB patients. The proportion of patients remaining alive in each health state, and healthcare costs and quality-adjusted life years (QALYs) were determined during annual cycles of these Markov models. The total healthcare costs, life years, and QALYs over the 40-year time horizon of the model were calculated. The perspectives of the cost-effectiveness analysis were the Korean healthcare system and the healthcare needs of the CHB patient.


RESULTS
Short-course therapy with alpha-interferon or 1-year treatment with pegylated interferon alpha-2a, lamivudine (LMV), or adefovir (ADV) had limited impact on disease progression. In contrast, either LMV-ADV or ADV-LMV as rescue medication administered for 5 years resulted in a more sustained decrease in the rate of disease progression. The cost-effectiveness threshold in Korea was estimated to be approximately 25,000,000 South Korean won. LMV administered for 1 year is cost-effective in comparison with no treatment for both HBeAg-positive and HBeAg-negative CHB patients, but longer duration antiviral therapies administered for up to 5 years in CHB patients were found to be highly cost-effective by international standards.


CONCLUSIONS
Antiviral treatment of CHB with LMV or ADV for up to 5 years using the alternative antiviral agent as rescue medication appears to be a cost-effective strategy for both HBeAg-positive and HBeAg-negative CHB patients in Korea. Economic evaluation of antiviral therapies should be studied further and updated, particularly for newer agents.
Kim
Byung Kook
BK
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Kwon
So Young
SY
Lee
Chang Hong
CH
Choe
Won Hyeok
WH
Choi
Hong Mi
HM
Koo
Hye Won
HW
D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D016898:Interferon-alpha / Q000191:economics* / Q000627:therapeutic use; D007723:Korea; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D015233:Models, Statistical; D063065:Organophosphonates / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D012720:Severity of Illness Index
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D016898:Interferon-alpha; D063065:Organophosphonates; D019259:Lamivudine; C053001:adefovir; D000225:Adenine