title: The cost-effectiveness of treating chronic hepatitis B patients in a median endemic and middle income country.
abstract: OBJECTIVE
  Chronic hepatitis B (CHB) infection is a serious public health problem due to its potential liver disease sequelae and highly expensive medical costs such as the need for liver transplantation. The aim of this study was to quantify the burden of active CHB in terms of mortality and morbidity, the eligibility of antiviral treatment and to assess various treatment scenarios and possible salvage combinations for cost-effectiveness.
  
  
  METHODS
  A population cohort from a large data base of chronic hepatitis B patients was constructed and stratified according to 10-year age groups, the prevalence of HBsAg, HBV DNA level, ALT level, HBeAg status and the presence of cirrhosis. An age-specific Markov model for disease progression and cost-effectiveness analysis was constructed and calibrated for the specific population setting.
  
  
  RESULTS
  Of about 3.2 million estimated HBsAg carriers, 25% are eligible for treatment. If the active cohort remains untreated, 31% will die due to liver related complications. Within a 20-year period, 11% will have developed decompensated cirrhosis, 12% liver cancer and 6% will need liver transplantation. Quality adjusted life years (QALYs) for the no treatment scenario ranged from 9.3 to 14.0. For scenarios with antiviral treatment, QALYs ranged from 9.9 to 14.5 for lamivudine, 13.0-17.5 for salvage therapy, and 16.6-19.0 for the third generation drugs entecavir and tenofovir.
  
  
  CONCLUSIONS
  In a country with considerable amount of active CHB patients, monotherapy with a highly potent third generation drug has the most health-gain, and is cost-effective in both HBeAg-positive and negative in all stages of liver disease.
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, 3000 CA, Rotterdam, The Netherlands, m.toy@erasmusmc.nl.
authors: Mehlika
authors: M
authors: Toy
authors: Fatih Oguz
authors: FO
authors: Onder
authors: Ramazan
authors: R
authors: Idilman
authors: Gokhan
authors: G
authors: Kabacam
authors: Jan Hendrik
authors: JH
authors: Richardus
authors: Mithat
authors: M
authors: Bozdayi
authors: Meral
authors: M
authors: Akdogan
authors: Zarife
authors: Z
authors: Kuloglu
authors: Aydan
authors: A
authors: Kansu
authors: Solko
authors: S
authors: Schalm
authors: Cihan
authors: C
authors: Yurdaydin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents