title: Cost-effectiveness analysis of different rescue therapies in patients with lamivudine-resistant chronic hepatitis B in China.
abstract: BACKGROUND
  Several rescue therapies have been used in patients with lamivudine (LAM)-resistant chronic hepatitis B (CHB); however, the economic outcome of these therapies is unclear. The object of the current analysis was to evaluate the lifetime cost-effectiveness of rescue therapies among patients with LAM-resistant CHB.
  
  
  METHODS
  A Markov model was developed to simulate the clinical course of patients with LAM-resistant CHB. From the perspective of Chinese health care, a lifetime cost-utility analysis was performedfor 4 rescue strategies: adefovir (ADV), entecavir (ETV) or tenofovir (TDF) monotherapy and combination therapy using LAM and ADV. A hypothetical cohort of 45-year-old patients with genotypic or clinical LAM-resistant CHB entered the model, and the beginning health state was LAM-resistant CHB without other complications. The transition probabilities, efficacy and resistance data for each rescue therapy as well as the costs and utility data were estimated from the literature. The discount rate (3%) utilized for costs and benefits. Sensitivity analyses were used to explore the impact of uncertainty on the results.
  
  
  RESULTS
  In LAM-resistant HBeAg-positive and HBeAg-negative CHB cohorts, TDF monotherapy and combination therapy were on the efficiency frontier for both positive and negative populations. Compared with no treatment, the use of combination therapy cost an additional $6,531.7 to gain 1 additional quality-adjusted life year (QALY) for HBeAg-positive patients and $4,571.7 to gain 1 additional QALY for HBeAg-negative patients. TDF monotherapy for HBeAg-positive patients, shows greater increase in QALYs but higher incremental cost-effectiveness ratio (ICER) in comparison with combination therapy. In probabilistic sensitivity analyses, combination therapy was the preferred option for health care systems with limited health resources, such as Chinese health care system.
  
  
  CONCLUSIONS
  In Chinese patients with LAM-resistant CHB, combination therapy is a more cost-effective option than the competing rescue therapies.
authors.affiliation: Department of Pharmacy Clinical Outcomes and Economics Group, Renji Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Dongfang Road 1630, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.forename: Jinfang
authors.initials: J
authors.lastname: Shen
authors.forename: Huafeng
authors.initials: H
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002681:China; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination / Q000191:economics; D004638:Emergency Treatment / Q000191:economics* / Q000379:methods; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D063065:Organophosphonates / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D016544:Patient Simulation; D011237:Predictive Value of Tests; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D019259:Lamivudine