title: [Cost-effectiveness of nucleoside/nucleotide analogues in chronic hepatitis B].
abstract: OBJECTIVE
  To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB).
  
  
  METHODS
  Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties.
  
  
  RESULTS
  Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine.
  
  
  CONCLUSIONS
  The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.
authors.affiliation: Programa de Pós-Graduação em Saúde Pública, Departamento de Medicina, Preventiva e Social., Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. alessandraalm@gmail.com
authors.forename: Alessandra Maciel
authors.initials: AM
authors.lastname: Almeida
authors.forename: Anderson Lourenço da
authors.initials: AL
authors.lastname: Silva
authors.forename: Cristina Mariano Ruas
authors.initials: CM
authors.lastname: Brandão
authors.forename: Mariângela Leal
authors.initials: ML
authors.lastname: Cherchiglia
authors.forename: Eli Iola Gurgel
authors.initials: EI
authors.lastname: Andrade
authors.forename: Gustavo Laine
authors.initials: GL
authors.lastname: Araújo de Oliveira
authors.forename: Ricardo Andrade
authors.initials: RA
authors.lastname: Carmo
authors.forename: Francisco de Assis
authors.initials: Fde A
authors.lastname: Acurcio
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D006147:Guanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D008390:Markov Chains; D008962:Models, Theoretical; D063065:Organophosphonates / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000068698:Tenofovir
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000068698:Tenofovir; D000225:Adenine