title: Should chronic hepatitis B be treated as early as possible?
abstract: OBJECTIVE
  We studied the cost-effectiveness of tenofovir and entecavir in e antigen positive (CHBe+) and negative (CHBe-) chronic hepatitis B.
  
  
  METHODS
  Using a multicenter survey including 544 patients we measured patient quality of life and attributable costs by clinical disease stage. Natural disease progression was studied in 278 patients in a single center. A Markov model was constructed to follow hypothetical cohorts of treated and untreated 40-year-old CHBe+ and CHBe- patients and 50-year-old patients with compensated cirrhosis.
  
  
  RESULTS
  We did not find an improvement in quality of life when viral load was reduced under treatment. Transition rates to liver cirrhosis were found to be age-dependent. Assuming equal effectiveness, tenofovir dominates the entecavir strategy because of its lower price in Belgium. The incremental cost-effectiveness ratio (ICER) of tenofovir after 20 years is more favorable for treating Caucasian cirrhotic patients (mean ICER €29,000/quality-adjusted life-year [QALY]) compared with treating non-cirrhotic patients (mean ICER €110,000 and 131,000/QALY for CHB e+ and e-, respectively). Within the non-cirrhotic patients the ICER decreases with increasing cohort starting age from 30 to 50 years.
  
  
  CONCLUSIONS
  Results of long-term models for tenofovir or entecavir treatment of CHB need to be interpreted with caution as long-term trials with hard end points are lacking. Especially the effect on HCC remains highly uncertain. Based on cost-effectiveness considerations such antiviral treatment should be targeted at patients with cirrhosis or at risk of rapid progression to this disease stage.
authors.affiliation: Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium. frank.hulstaert@kce.fgov.be
authors.forename: Frank
authors.initials: F
authors.lastname: Hulstaert
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwierz
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
authors.forename: Nancy
authors.initials: N
authors.lastname: Thiry
authors.forename: Mohamed
authors.initials: M
authors.lastname: Gamil
authors.forename: Isabelle
authors.initials: I
authors.lastname: Colle
authors.forename: Stefaan
authors.initials: S
authors.lastname: Van de Sande
authors.forename: Yves
authors.initials: Y
authors.lastname: Horsmans
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D001530:Belgium; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D006147:Guanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D019538:Health Care Surveys; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology; D008390:Markov Chains; D008875:Middle Aged; D063065:Organophosphonates / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D055502:Secondary Prevention; D000068698:Tenofovir; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000225:Adenine