title: Incorporated antivirals for chronic hepatitis B in Brazil: a cost-effectiveness analysis.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of different drug therapies for chronic hepatitis B in adult patients.
  
  
  METHODS
  Using a Markov model, a hypothetical cohort of 40 years for HBeAg-positive or HBeAg-negative patients was constructed. Adefovir, entecavir, tenofovir and lamivudine (with rescue therapy in cases of viral resistance) were compared for treating adult patients with chronic hepatitis B undergoing treatment for the first time, with high levels of alanine aminotransferase, no evidence of cirrhosis and without HIV co-infection. Values for cost and effect were obtained from the literature, and expressed in effect on life years (LY). A discount rate of 5% was applied. Univariate sensitivity analysis was conducted to assess model uncertainties.
  
  
  RESULTS
  Initial treatment with entecavir or tenofovir showed better clinical outcomes. The lowest cost-effectiveness ratio was for entecavir in HBeAg-positive patients (R$ 4,010.84/LY) and lamivudine for HBeAg-negative patients (R$ 6,205.08/LY). For HBeAg-negative patients, the incremental cost-effectiveness ratio of entecavir (R$ 14,101.05/LY) is below the threshold recommended by the World Health Organization. Sensitivity analysis showed that variation in the cost of drugs may make tenofovir a cost-effective alternative for both HBeAg-positive and HBeAg-negative patients.
  
  
  CONCLUSIONS
  Entecavir is the recommended alternative to start treating patients with chronic hepatitis B in Brazil. However, if there is a reduction in the cost of tenofovir, it can become a cost-effective alternative.
authors.affiliation: Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo HorizonteMG, Brasil.
authors.forename: Gustavo Laine Araújo de
authors.initials: GL
authors.lastname: Oliveira
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Ciências Médicas de Minas Gerais, Belo HorizonteMG, Brasil.
authors.forename: Alessandra Maciel
authors.initials: AM
authors.lastname: Almeida
authors.affiliation: Superintendente de Assistência Farmacêutica e Insumos Estratégicos, Secretaria de Estado de Saúde, Rio de JaneiroRJ, Brasil.
authors.forename: Anderson Lourenço da
authors.initials: AL
authors.lastname: Silva
authors.affiliation: Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo HorizonteMG, Brasil.
authors.forename: Cristina Mariano Ruas
authors.initials: CM
authors.lastname: Brandão
authors.affiliation: Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo HorizonteMG, Brasil.
authors.forename: Eli Iola Gurgel
authors.initials: EI
authors.lastname: Andrade
authors.affiliation: Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo HorizonteMG, Brasil.
authors.forename: Mariângela Leal
authors.initials: ML
authors.lastname: Cherchiglia
authors.affiliation: Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo HorizonteMG, Brasil.
authors.forename: Francisco de Assis
authors.initials: Fde A
authors.lastname: Acurcio
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000145:classification / Q000191:economics* / Q000627:therapeutic use; D001938:Brazil; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006147:Guanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000191:economics / Q000627:therapeutic use; D008390:Markov Chains; D063065:Organophosphonates / Q000191:economics / Q000627:therapeutic use; D000068698:Tenofovir; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000068698:Tenofovir; D000225:Adenine