title: Cost effectiveness of response-guided therapy with peginterferon in the treatment of chronic hepatitis B.
abstract: OBJECTIVE
  The high prevalence of chronic hepatitis B in Asian countries produces a substantial economic burden. Peginterferon has immunomodulatory effects and a finite course for treatment of hepatitis B, but also a high cost and side effects. The recent introduction of a 12-week stopping rule (stopping treatment after 12 weeks) has increased its appeal as a first-line treatment for hepatitis B. We aimed to determine the cost effectiveness of the 12-week stopping rule for peginterferon in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients.
  
  
  METHODS
  We used Markov modeling, with data from the Hong Kong population, to compare the cost effectiveness of peginterferon therapy with a 12-week stopping rule vs conventional therapy (48 weeks) and with other antiviral agents.
  
  
  RESULTS
  For HBeAg-positive patients, stopping peginterferon therapy after 12 weeks had the lowest cost-effectiveness ratio (CER), of $9501/quality-adjusted life-year (QALY), compared with no treatment, making it the most cost-effective option. Conventional (48-week) peginterferon treatment had a CER of $9664/QALY. For HBeAg-negative patients, entecavir had the lowest CER ($34,310/QALY). Entecavir was more cost effective than either peginterferon strategies (CERs of $37,423/QALY for 12 weeks of peginterferon and $38,474/QALY for 48 weeks of treatment).
  
  
  CONCLUSIONS
  The 12-week stopping rule increases the cost effectiveness of peginterferon therapy, and is the most cost-effective treatment for HBeAg-positive patients. The need for long-term antiviral therapy for HBeAg-negative patients makes entecavir the most cost-effective strategy.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China.
authors.forename: Angeline Oi-Shan
authors.initials: AO
authors.lastname: Lo
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China.
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore. Electronic address: yock_young_dan@nuhs.edu.sg.
authors.forename: Yock-Young
authors.initials: YY
authors.lastname: Dan
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016903:Drug Monitoring / Q000191:economics / Q000379:methods*; D004358:Drug Therapy / Q000191:economics / Q000379:methods; D005260:Female; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics; D006723:Hong Kong; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000191:economics; D008297:Male
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D016898:Interferon-alpha; C413685:entecavir; D006147:Guanine
keywords: Drug Resistance; HBsAg Seroclearance; Roadmap Approach; Suboptimal Responders