title: Economic analysis between entecavir and lamivudine for the treatment of chronic hepatitis B in Hong Kong.
abstract: OBJECTIVE
  Tremendous healthcare resources have been spent on the management of chronic hepatitis B (CHB) and its related complications. Therefore, a proper evaluation of the cost-effectiveness of pharmacotherapy is vital in aid of decision-making. The aim of the present study was to examine the long-term economic and clinical influence if lamivudine was replaced by entecavir in a group of CHB patients.
  
  
  METHODS
  A recently published decision analytic model was adapted to study the cost-effectiveness of 2 years of treatment of entecavir in a hypothetical cohort of 1000 hepatitis B e antigen (HBeAg)-negative CHB patients from a public hospital perspective. Compensated cirrhosis (CC) and de-compensated cirrhosis (DC) and hepatocellular carcinoma (HCC) events were projected to 10 years. Hong Kong-specific health care costs were used. Quality Adjusted Life Years (QALYs) were calculated using the utility values obtained from a local study.
  
  
  RESULTS
  In the base case analysis, compared with lamivudine, the use of entecavir was expected to reduce the incidences of CC, DC and HCC by 41.8%, 57.1% and 49.3%, respectively, and lead to a saving of $US 1.17 million in medical cost. The overall disease management cost for entecavir, which was 67.7% higher than lamivudine for 2 years treatment was reduced to 17.2% after projecting 2-year treatment duration to 10 years. The incremental cost per QALY gained for entecavir compared with lamivudine was $US 13 759.
  
  
  CONCLUSIONS
  Based on the recommended cost-effectiveness threshold of the World Health Organization, entecavir is considered cost-effective compared with lamivudine in treating CHB in Hong Kong when long term medical consequences were considered.
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. kenneth.lee@med.monash.edu.my
authors.forename: Kenneth K C
authors.initials: KK
authors.lastname: Lee
authors.forename: David Bin Chia
authors.initials: DB
authors.lastname: Wu
authors.forename: Pui Yu
authors.initials: PY
authors.lastname: Chow
authors.forename: Vivian Wing Yan
authors.initials: VW
authors.lastname: Lee
authors.forename: Hong
authors.initials: H
authors.lastname: Li
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000517:prevention & control / Q000821:virology; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000097:blood; D016527:Drug Costs / Q000706:statistics & numerical data; D024882:Drug Resistance, Viral; D006147:Guanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics* / Q000821:virology; D006723:Hong Kong; D006779:Hospitals, Public; D006801:Humans; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000191:economics / Q000517:prevention & control / Q000821:virology; D008113:Liver Neoplasms / Q000191:economics / Q000517:prevention & control / Q000821:virology; D019057:Quality-Adjusted Life Years; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D019259:Lamivudine; C413685:entecavir; D006147:Guanine