title: Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients.
abstract: OBJECTIVE
  Lamivudine (LAM) plus adefovir (ADV) combination therapy is clinically efficacious for treating chronic hepatitis B (CHB) patients in China, but no pharmacoeconomic evaluations of this strategy are available. The aim of this study was to examine the cost-effectiveness of LAM plus ADV combination treatment compared with five other nucleos(t)ide analog monotherapies (LAM, ADV, telbivudine [TBV], entecavir [ETV], and tenofovir [TDF]).
  
  
  METHODS
  To simulate the lifetime (40-year time span) costs and quality-adjusted life-years (QALYs) for different therapy options, a Markov model that included five initial monotherapies and LAM plus ADV combination as an initial treatment was developed. Two kinds of rescue combination strategies (base-case: LAM + ADV then ETV + ADV; alternative: direct use of ETV + ADV) were considered separately for treating patients refractory to initial therapy. One-way and probabilistic sensitivity analyses were used to explore model uncertainties.
  
  
  RESULTS
  In base-case analysis, ETV had the lowest lifetime cost and served as the reference therapy. Compared to the reference, LAM, ADV, and TBV had higher costs and lower efficacy, and were completely dominated by ETV. LAM plus ADV combination therapy or TDF was more efficacious than ETV, but also more expensive. Although the incremental cost-effectiveness ratios of combination therapy or TDF were both higher than the willingness-to-pay threshold of $20,466/QALY gained for the reference treatment, in an alternative scenario analysis LAM plus ADV combination therapy would be the preferable treatment option.
  
  
  CONCLUSIONS
  ETV and LAM plus ADV combination therapy are both cost-effective strategies for treating Chinese CHB patients.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Weixia
authors.initials: W
authors.lastname: Ke
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Yanhui
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Zhenjiang
authors.initials: Z
authors.lastname: Yao
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Shudong
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use*; D009705:Nucleosides / Q000191:economics* / Q000627:therapeutic use*; D063065:Organophosphonates / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D009705:Nucleosides; D063065:Organophosphonates; D019259:Lamivudine; C053001:adefovir; D000225:Adenine
keywords: chronic hepatitis B; combination treatment; cost-effectiveness; nucleos(t)ide analog