title: Cost-Effectiveness Comparison Between the Response-Guided Therapies and Monotherapies of Nucleos(t)ide Analogues for Chronic Hepatitis B Patients in China.
abstract: OBJECTIVE
  Nucleos(t)ide analogue (NA) monotherapies are typically used as the primary treatment for chronic hepatitis B (CHB) patients, including lamivudine (LAM), telbivudine (TBV), adefovir (ADV), entecavir (ETV) and tenofovir (TDF). For high-resistance NAs (LAM, TBV, ADV), they can generate excellent clinical outcomes by using response-guided therapy; however, their pharmacoeconomic profiles remain unclear in China. We aimed to evaluate the cost effectiveness between response-guided therapies and monotherapies of NAs for Chinese hepatitis B e-antigen (HBeAg)-positive and -negative CHB patients.
  
  
  METHODS
  We constructed a Markov model to simulate CHB progression associated with 12 treatment strategies using effectiveness and cost data from the published literature. We measured the lifetime costs, quality adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way sensitivity (especially to extend the range of the TDF price) and probabilistic sensitivity analyses were used to explore the uncertainties of the model.
  
  
  RESULTS
  For both HBeAg-positive and -negative patients, no treatment strategy generated the lowest lifetime costs (US$31,185-US$31,338) and QALYs (7.54-7.58). ETV and TDF monotherapies were not dominated by other treatments, whereas, the ICER of ETV monotherapy was the lowest (US$6112/QALY-US$8533/QALY). For each high-resistance NA, compared with its monotherapy, the ICERs of its response-guided therapies were below the willingness-to-pay threshold of US$22,833/QALY. Additionally, TDF monotherapy was the preferred treatment when its price dropped to US$1820/year or lower.
  
  
  CONCLUSIONS
  Among 12 treatment strategies evaluated, ETV monotherapy is the most cost-effective treatment for treatment-naive CHB patients in China. The response-guided therapies of high-resistance NAs are more cost-effective than their monotherapies.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou, 510310, Guangdong Province, China.
authors.forename: Keng
authors.initials: K
authors.lastname: Lai
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou, 510310, Guangdong Province, China.
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou, 510310, Guangdong Province, China.
authors.forename: Weixia
authors.initials: W
authors.lastname: Ke
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou, 510310, Guangdong Province, China.
authors.forename: Yanhui
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou, 510310, Guangdong Province, China.
authors.forename: Shudong
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou, 510310, Guangdong Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou, 510310, Guangdong Province, China. yangyigz@163.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D002681:China; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006147:Guanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006513:Hepatitis B e Antigens / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D019057:Quality-Adjusted Life Years
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; C413685:entecavir; D006147:Guanine