Modeling the cost-effectiveness of different oral antiviral therapies in patients with chronic hepatitis B.
OBJECTIVE
Chronic hepatitis B (CHB) is a common disease associated with high morbidity, mortality and impact on healthcare costs. Several oral antiviral therapies can lead to complete virologic response, which is associated with prevention of disease progression. The aim of this study was to estimate the cost-effectiveness of the oral antiviral treatments lamivudine, adefovir, telbivudine, entecavir and tenofovir, in patients with CHB.


METHODS
A Markov model was used to project the lifetime complications and costs in cohorts of both HBeAg-positive and HBeAg-negative CHB patients treated with one of the above drugs or no treatment. Rescue therapy with two different combination therapies (adefovir plus lamivudine or tenofovir plus entecavir) with their corresponding costs and efficacy rates was also considered. The probabilities of disease progression were based on serum HBV DNA levels. Disease and complication costs were assessed using the perspective of the Spanish National Health System.


RESULTS
The highest rate of virologic response was obtained with tenofovir, and this translated to its higher life years saved (LYS) and quality adjusted life years (QALY) compared with the rest of the alternatives in HBeAg-positive and HBeAg-negative patients. Tenofovir is associated with lower costs and higher efficacy over entecavir, telbivudine and adefovir in HBeAg-positive patients, and telbivudine and entecavir in HBeAg-negative patients. The incremental cost-effectiveness ratios with respect to the rest of the alternatives are below the common reference efficiency threshold of 30,000 euro per LYS/QALY.


CONCLUSIONS
In chronic HBV infected patients, tenofovir is a cost-effective or even cost-saving strategy compared with other available treatment options for CHB.
Buti
Maria
M
Servicio de Hepatologi a, Hospital Vall d'Hebrón and Ciber-ehd del Instituto Carlos III, Barcelona, Spain. mbuti@vhebron.net
Brosa
Max
M
Casado
Miguel A
MA
Rueda
Magdalena
M
Esteban
Rafael
R
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000821:virology; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D063065:Organophosphonates / Q000008:administration & dosage / Q000191:economics; D019057:Quality-Adjusted Life Years; D000068698:Tenofovir
D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine