title: Cost-effectiveness and cost-utility of the treatment of chronic hepatitis B with peginterferon alfa-2a, interferon alfa, and lamivudine in Lithuania.
abstract: BACKGROUND
  Chronic hepatitis B infection is an important health care problem worldwide. According to the World Health Organization, 10% to 15% of population is infected with hepatitis B virus. Nearly 100 new cases of acute hepatitis B are annually registered in Lithuania, but official statistics covers only 8-25% of all disease incidence. The aim of this study was to evaluate the cost-effectiveness of the treatment of chronic hepatitis B with peginterferon alfa-2a and compare it to treatment with interferon alfa and lamivudine in Lithuania.
  
  
  METHODS
  A Markov model was used to evaluate long-term cost-effectiveness of the treatment with peginterferon alfa-2a and to compare it with treatment with interferon alfa and lamivudine. Peginterferon alfa-2a was administered by subcutaneous injections at a dosage of 180 μg every week for 48 weeks; interferon alfa, 6 million IU three times a week for 24 weeks; and lamivudine, 100 mg per day from 48 weeks to 5 years for HBeAg-positive chronic hepatitis B and 100 mg per day up to 5 years in HBeAg-negative chronic hepatitis B.
  
  
  RESULTS
  Treatment with peginterferon alfa-2a gained 1.179 life years as compared to 0.658 life years gained with treatment with interferon alfa; incremental costs per incremental life-year gained (LYG) were 51,256.92 Lt (14,845.03 €). Treatment with peginterferon alfa-2a gained 0.545 quality-adjusted life-years (QALYs) with incremental costs per incremental QALY of 48,980.08 Lt (14,185.61 €). Treatment with peginterferon alfa-2a had twice higher cost-effectiveness than treatment with interferon alfa: 50,4167.00 Lt (146,016.85 €) vs. 954,020.08 Lt (276,303.31 €), respectively. Costs for a complete response were also twice lower. Treatment with peginterferon alfa-2a gained 0.757 incremental LYG more compared to lamivudine (48-week course). Comparing incremental cost-effectiveness using peginterferon alfa-2a for treatment, incremental costs per incremental LYG were 41,993.67 Lt (12,162.21 €); additionally there was a gain of 0.792 incremental QALYs, while incremental costs for incremental QALY were 40,096.19 Lt (11,612.66 €). Complete response costs were 83,515.98 Lt (24,187.89 €) less compared to lamivudine (48-week course).
  
  
  CONCLUSIONS
  Treatment of chronic hepatitis B prolongs patients' overall survival and quality-adjusted life. Peginterferon alfa-2a was the most effective drug registered in Lithuania for CHB treatment.
authors.affiliation: Department of Preventive Medicine, Medical Academy, Lithuanian University of Health Sciences, Eivenių 4, 50161 Kaunas, Lithuania. vanagas@kmu.lt
authors.forename: Giedrius
authors.initials: G
authors.lastname: Vanagas
authors.forename: Zilvinas
authors.initials: Z
authors.lastname: Padaiga
authors.forename: Aušra
authors.initials: A
authors.lastname: Mickevičienė
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D019259:Lamivudine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008097:Lithuania; D008390:Markov Chains; D018803:Models, Economic; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D011788:Quality of Life; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D016019:Survival Analysis
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D019259:Lamivudine; D011092:Polyethylene Glycols; C100416:peginterferon alfa-2a