Cost-utility analysis of tenofovir disoproxil fumarate in the treatment of chronic hepatitis B.
OBJECTIVE
The aim of this study was to assess the cost-effectiveness of tenofovir disoproxil fumarate (TDF) in the treatment of chronic hepatitis B (CHB) versus alternative nucleos(t)ides from a UK National Health Service (NHS) perspective.


METHODS
A Markov model was used to calculate costs and benefits of nucleos(t)ide strategies in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with hepatitis B virus mono-infection and compensated liver disease. The model included 18 disease states representing CHB progression. Quality-of-life data and costs for severe disease states were based on published studies, while monitoring costs for other disease states were based on expert opinion. Transition probabilities for movements between states were based on a meta-analysis, clinical trials, and natural history studies.


RESULTS
First-line TDF generated the highest net benefits of all 211 nucleos(t)ide strategies evaluated at a threshold of £ 20,000 per quality-adjusted life-year (QALY) gained. First-line TDF cost £ 19,084/QALY gained compared with giving lamivudine (LAM) first-line and switching to TDF when LAM resistance occurs. First-line TDF was also more effective and less costly than first-line entecavir (ETV), and showed extended dominance over first-line adefovir and strategies reserving adefovir, ETV, or combination therapy until after LAM resistance develops. For patients who have developed LAM resistance, TDF was also the most cost-effective treatment, generating greater net benefits than any other second-line strategy.


CONCLUSIONS
First-line TDF is the most cost-effective treatment for patients with CHB at a £ 20,000 to £ 30,000/QALY ceiling ratio, costing £ 19,084/QALY gained compared with the next best alternative.
Dakin
Helen
H
Abacus International, Bicester, Oxfordshire, UK. helen.dakin@abacusint.com
Bentley
Anthony
A
Dusheiko
Geoff
G
D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006147:Guanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D063065:Organophosphonates / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D018894:Reverse Transcriptase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D013222:State Medicine / Q000191:economics*; D000068698:Tenofovir; D006113:United Kingdom
D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000225:Adenine; C106812:adefovir dipivoxil