BACKGROUND:Peginterferon alpha-2a (40 kDa), a new treatment for chronic hepatitis B, produces seroconversion within 48 weeks in approximately 32% of HBeAg-positive patients. Over a defined treatment duration it offers improved efficacy over lamivudine, but at higher cost. We assessed the clinical outcomes and costs, from the perspective of the UK National Health Service, of 48 weeks of peginterferon alpha-2a (40 kDa) vs. 4 years of lamivudine. METHODS:Cost-effectiveness was analysed using a state-transition Markov model simulating HBeAg-positive chronic hepatitis B natural history. Efficacy data were obtained from a large randomized trial comparing peginterferon alpha-2a (40 kDa) with lamivudine over 48 weeks. Use of adefovir salvage treatment for lamivudine-resistant patients was also evaluated. Long-term lamivudine efficacy, treatment durability, disease progression, cost, and quality-of-life estimates were derived from the literature. One-way and probabilistic sensitivity analyses evaluated uncertainty. RESULTS: Treatment with peginterferon alpha-2a (40 kDa) for 48 weeks resulted in higher discounted total healthcare costs ( pound 3100), but an increase of 0.3 discounted quality-adjusted life years compared with long-term lamivudine, giving an incremental cost-effectiveness ratio of pound 10,400 per quality-adjusted life year gained ( pound 8300- pound 15,400 in one-way sensitivity analyses). The cost-effectiveness acceptability curve showed intervention was below the pound 30,000/QALY threshold in over 95% of the simulations. When adefovir was included for patients with lamivudine resistance, peginterferon alpha-2a (40 kDa) had an incremental cost of pound 6100/QALY gained. CONCLUSIONS: Treatment with peginterferon alpha-2a (40 kDa) for a defined duration of 48 weeks, although more expensive than lamivudine therapy, provides improvement in health outcomes, with a cost-effectiveness ratio well below the current UK cost-effectiveness threshold.
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BACKGROUND: Peginterferon alpha-2a (40 kDa), a new treatment for chronic hepatitis B, produces seroconversion within 48 weeks in approximately 32% of HBeAg-positive patients. Over a defined treatment duration it offers improved efficacy over lamivudine, but at higher cost. We assessed the clinical outcomes and costs, from the perspective of the UK National Health Service, of 48 weeks of peginterferon alpha-2a (40 kDa) vs. 4 years of lamivudine. METHODS: Cost-effectiveness was analysed using a state-transition Markov model simulating HBeAg-positive chronic hepatitis B natural history. Efficacy data were obtained from a large randomized trial comparing peginterferon alpha-2a (40 kDa) with lamivudine over 48 weeks. Use of adefovir salvage treatment for lamivudine-resistant patients was also evaluated. Long-term lamivudine efficacy, treatment durability, disease progression, cost, and quality-of-life estimates were derived from the literature. One-way and probabilistic sensitivity analyses evaluated uncertainty. RESULTS: Treatment with peginterferon alpha-2a (40 kDa) for 48 weeks resulted in higher discounted total healthcare costs ( pound 3100), but an increase of 0.3 discounted quality-adjusted life years compared with long-term lamivudine, giving an incremental cost-effectiveness ratio of pound 10,400 per quality-adjusted life year gained ( pound 8300- pound 15,400 in one-way sensitivity analyses). The cost-effectiveness acceptability curve showed intervention was below the pound 30,000/QALY threshold in over 95% of the simulations. When adefovir was included for patients with lamivudine resistance, peginterferon alpha-2a (40 kDa) had an incremental cost of pound 6100/QALY gained. CONCLUSIONS: Treatment with peginterferon alpha-2a (40 kDa) for a defined duration of 48 weeks, although more expensive than lamivudine therapy, provides improvement in health outcomes, with a cost-effectiveness ratio well below the current UK cost-effectiveness threshold.
Authors: Stuart Mealing; Isabella Ghement; Neil Hawkins; David A Scott; Benedicte Lescrauwaet; Maureen Watt; Mark Thursz; Pietro Lampertico; Lorenzo Mantovani; Edith Morais; Bruno Bregman; Michel Cucherat Journal: Syst Rev Date: 2014-03-07
Authors: Shehzad Ali; Stuart Mealing; Neil Hawkins; Benedicte Lescrauwaet; Stefan Bjork; Lorenzo Mantovani; Pietro Lampertico Journal: BMJ Open Date: 2013-01-24 Impact factor: 2.692