title: A cost-utility analysis of drug treatments in patients with HBeAg-positive chronic hepatitis B in Thailand.
abstract: BACKGROUND
  Only lamivudine has been included for patients with chronic hepatitis B (CHB) in the National List of Essential Drugs (NLED), a pharmaceutical reimbursement list in Thailand. There have also been no economic evaluation studies of CHB drug treatments conducted in Thailand yet. In order to fill this gap in policy research, the objective of this study was to compare the cost-utility of each drug therapy (Figure 1) with palliative care in patients with HBeAg-positive CHB.
  
  
  METHODS
  A cost-utility analysis using an economic evaluation model was performed to compare each drug treatment for HBeAg-positive CHB patients. A Markov model was used to estimate the relevant costs and health outcomes during a lifetime horizon based on a societal perspective. Direct medical costs, direct non-medical costs, and indirect costs were included, and health outcomes were denoted in life years (LYs) and quality-adjusted life years (QALYs). The results were presented as an incremental cost effectiveness ratio (ICER) in Thai baht (THB) per LY or QALY gained. One-way sensitivity and probabilistic sensitivity analyses were applied to investigate the effects of model parameter uncertainties.
  
  
  RESULTS
  The ICER values of providing generic lamivudine with the addition of tenofovir when drug resistance occurred, generic lamivudine with the addition of tenofovir based on the road map guideline, and tenofovir monotherapy were -14,000 (USD -467), -8,000 (USD -267) , and -5,000 (USD -167) THB per QALY gained, respectively. However, when taking into account all parameter uncertainties in the model, providing generic lamivudine with the addition of tenofovir when drug resistance occurred (78% and 75%) and tenofovir monotherapy (18% and 24%) would yield higher probabilities of being cost-effective at the societal willingness to pay thresholds of 100,000 (USD 3,333) and 300,000 (USD 10,000) THB per QALY gained in Thailand, respectively.
  
  
  CONCLUSIONS
  Based on the policy recommendations from this study, the Thai government decided to include tenofovir into the NLED in addition to generic lamivudine which is already on the list. Moreover, the results have shown that the preferred treatment regimen involves using generic lamivudine as the first-line drug with tenofovir added if drug resistance occurs in HBeAg-positive CHB patients.
authors.forename: Narisa
authors.initials: N
authors.lastname: Tantai
authors.affiliation: Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayudthaya Road, Payathai, Ratchathewi, Bangkok 10400, Thailand. usa.chi@mahidol.ac.th.
authors.forename: Usa
authors.initials: U
authors.lastname: Chaikledkaew
authors.forename: Tawesak
authors.initials: T
authors.lastname: Tanwandee
authors.forename: Pitsaphun
authors.initials: P
authors.lastname: Werayingyong
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018954:Drugs, Essential / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006302:Health Services Research; D006513:Hepatitis B e Antigens; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D063065:Organophosphonates / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000068698:Tenofovir; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D018954:Drugs, Essential; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D019259:Lamivudine; D000068698:Tenofovir; D000225:Adenine
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