Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy.
BACKGROUND
The roadmap approach is recommended to guide chronic hepatitis B treatment. We evaluated the cost-effectiveness of various treatment strategies in the global market.


METHODS
Lamivudine and telbivudine were tested in roadmap models with switch-to tenofovir if HBV was detectable at week 24 or add-on tenofovir if resistance developed at year 1. Tenofovir and entecavir were tested as continuous monotherapy. In the reference arm, lamivudine was used with add-on tenofovir if resistance developed at year 1. The primary measure of effectiveness was undetectable HBV DNA at year 2. Cost-effectiveness was measured by incremental cost-effectiveness ratio (ICER) in US dollars against the reference arm.


RESULTS
In the US and Germany, costs of the reference arms were US $14,486 and US $9,998 for hepatitis B e antigen (HBeAg)-positive and US $11,398 and US $7,531 for HBeAg-negative patients, respectively. In HBeAg-positive patients, the lamivudine roadmap was most cost-effective (ICER US $15,260 in the US and US $29,113 in Germany) with comparable effectiveness (75.1%) to other strategies. In HBeAg-negative patients, tenofovir and entecavir monotherapies were most effective (91-96%) and cost-effective (ICER US $31,297-43,387 in the US and US $53,976-59,822 in Germany). In Asia, where telbivudine cost was lower, both telbivudine and lamivudine roadmaps were cost-effective in HBeAg-positive patients. Tenofovir would be most cost-effective in HBeAg-negative patients if its cost equaled that of telbivudine in Asia.


CONCLUSIONS
In HBeAg-positive patients, lamivudine roadmap was most cost-effective; in Asia, telbivudine roadmap had comparable cost-effectiveness to lamivudine roadmap because of the relatively low price of telbivudine. In HBeAg-negative patients, entecavir and tenofovir monotherapies were more cost-effective than the roadmap models.
Lui
Yanni Yan-Ni
YY
Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Terrritories, Hong Kong.
Tsoi
Kelvin Kam-Fai
KK
Wong
Vincent Wai-Sun
VW
Kao
Jia-Horng
JH
Hou
Jin-Lin
JL
Teo
Eng-Kiong
EK
Mohamed
Rosmawati
R
Piratvisuth
Teerha
T
Han
Kwang-Hyub
KH
Mihm
Ulrike
U
Wong
Grace Lai-Hung
GL
Chan
Henry Lik-Yuen
HL
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics; D001208:Asia; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000097:blood; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005858:Germany; D006515:Hepatitis B virus / Q000187:drug effects; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000191:economics / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000191:economics; D018803:Models, Economic; D009705:Nucleosides / Q000008:administration & dosage / Q000191:economics; D063065:Organophosphonates / Q000008:administration & dosage / Q000191:economics; D011744:Pyrimidinones / Q000008:administration & dosage / Q000191:economics; D016879:Salvage Therapy / Q000191:economics; D000077712:Telbivudine; D000068698:Tenofovir; D013936:Thymidine / Q000031:analogs & derivatives; D016896:Treatment Outcome; D014481:United States
D000998:Antiviral Agents; D004279:DNA, Viral; D009705:Nucleosides; D063065:Organophosphonates; D011744:Pyrimidinones; D000077712:Telbivudine; D019259:Lamivudine; D000068698:Tenofovir; D000225:Adenine; D013936:Thymidine