Lamivudine compared with newer antivirals for prophylaxis of hepatitis B core antibody positive livers: a cost-effectiveness analysis.
There is concern over the development of de novo hepatitis B in patients receiving liver transplants from hepatitis B surface antigen negative, hepatitis B core antibody positive donors. Current practice is to place such patients on indefinite lamivudine prophylaxis; however, there is a small risk of breakthrough infection and newer antivirals for hepatitis B are available. The objective of this study was to determine the cost-effectiveness of lamivudine compared with the newer agents, tenofovir and entecavir, in the prophylaxis setting using a Markov model. Three strategies were examined which consisted of either lamivudine or entecavir monoprophylaxis with tenofovir add-on therapy after breakthrough or tenofovir monoprophylaxis with emtricitabine add-on therapy after breakthrough. In the base case scenario, lamivudine was the most cost-effective option at a threshold of $100 000 per quality-adjusted life-year and this remained robust despite parameter uncertainty. Tenofovir had an incremental cost-effectiveness ratio of $3 540 194.77 while other strategies were superior to entecavir therapy. Until drug costs decrease, lamivudine remains the most cost-effective option for hepatitis B prophylaxis in the liver transplant setting.
Infectious Disease Division, Massachusetts General Hospital, Boston, MA.
A J
AJ
Wright
J A
JA
Fishman
R T
RT
Chung
D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005500:Follow-Up Studies; D006085:Graft Survival; D006147:Guanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006509:Hepatitis B / Q000191:economics* / Q000276:immunology / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000502:physiology; D006801:Humans; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D016031:Liver Transplantation / Q000191:economics; D008390:Markov Chains; D063065:Organophosphonates / Q000191:economics* / Q000627:therapeutic use; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D015996:Survival Rate; D000068698:Tenofovir
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000225:Adenine
Cost-effectiveness; health economics; hepatitis B virus; liver transplantation; prophylaxis