title: Cost-effectiveness analysis of antiviral treatments for HBeAg-positive chronic hepatitis B in Canada.
abstract: OBJECTIVE
  To conduct a cost-effectiveness analysis of currently available nucleos(t)ide antiviral treatments (lamivudine, telbivudine, entecavir, and tenofovir) for chronic hepatitis B in Canada.
  
  
  METHODS
  Markov modeling was used to project the lifetime health benefits and costs associated with the antiviral treatments. The hypothetical patient population was hepatitis B e antigen-positive chronic hepatitis B-infected patients aged 34 years. Quality-adjusted life-years were used as a measure of effectiveness. Long-term cumulative incidence of liver complications was also projected. Treatment effectiveness data were derived from the literature; meta-analysis was conducted when there was a large variance in reported effectiveness data. Costs were obtained from a cost analysis of treating chronic hepatitis B-related complications in Canada. Stochastic parameter uncertainty was examined in probabilistic sensitivity analysis by using second-order Monte Carlo simulation. Alternative modeling assumptions were assessed in scenario analysis. One-way sensitivity analysis was used to explore each parameter's impact on the uncertainty of the results.
  
  
  RESULTS
  In the base-case analysis, telbivudine was dominated by entecavir and tenofovir. Tenofovir strictly dominated lamivudine, telbivudine, and entecavir. Over the 72-year period of the model, the expected life expectancy (undiscounted) of lamivudine, telbivudine, entecavir, and tenofovir was 35.71, 36.94, 37.65, and 37.99 years, respectively. Tenofovir had the highest expected quality-adjusted life-years at 11.86 (discounted) in all comparisons. Scenario and sensitivity analyses proved the robustness of the base-case results. The projected 10-year cumulative incidence of cirrhosis and hepatocellular carcinoma was 11.40% and 3.05%, respectively, for tenofovir, which is significantly lower than that for lamivudine.
  
  
  CONCLUSIONS
  Tenofovir generated the best results compared with all other therapies under evaluation.
authors.affiliation: Canadian Institute for Health Information, Toronto, ON, Canada. mail.jinghe@gmail.com
authors.forename: Jing
authors.initials: J
authors.lastname: He
authors.forename: James M
authors.initials: JM
authors.lastname: Bowen
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D008390:Markov Chains; D019057:Quality-Adjusted Life Years
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens